| Statins and chronic heart failure: do we need a large-scale outcome trial? | |
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MedLine Citation:
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PMID: 12020481 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) are of proven clinical benefit in coronary heart disease, at least in those patients who do not have overt chronic heart failure (CHF). However, as there have been no prospective clinical trials of statins in CHF patients, the question arises as to whether the benefits observed in the absence of CHF can be necessarily inferred in those patients in whom CHF is established. In this review, the evidence base stating support of the use of statins in CHF is presented, as well as theoretical considerations as to why these agents may not necessarily be of benefit in this setting. The beneficial potential of statins clearly relates to their plaque stabilization properties and associated improvements in endothelial function, which together should reduce the risk of further infarction and, perhaps, the ischemic burden on the failing ventricle. Furthermore, these agents may have beneficial effects independent of lipid lowering. These include actions on neoangiogenesis, downregulation of AT(1) receptors, inhibition of proinflammatory cytokine activity and favorable modulation of the autonomic nervous system. The potential adverse effects of statins in CHF include reduction in levels of coenzyme Q10 (which may further exacerbate oxidative stress in CHF) and loss of the protection that lipoproteins may provide through binding and detoxifying endotoxins entering the circulation via the gut. In support of these possibilities are epidemiologic data linking a lower serum cholesterol with a poorer prognosis in CHF. These uncertainties indicate the need for a definitive outcome trial to assess the efficacy and safety of statins in CHF, despite their current widespread, non-evidence based use in this population. |
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Authors:
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Henry Krum; John J McMurray |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 39 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2002 May |
Date Detail:
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Created Date: 2002-05-21 Completed Date: 2002-06-06 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1567-73 Citation Subset: AIM; IM |
Affiliation:
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Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Prahan Victoria, Australia. henry.krum@med.monash.edu.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anticholesteremic Agents
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adverse effects,
therapeutic use* Cholesterol / blood Chronic Disease Heart Failure / blood, drug therapy*, mortality Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects, therapeutic use* Outcome Assessment (Health Care) Prospective Studies Survival Rate Ubiquinone / blood |
| Chemical | |
Reg. No./Substance:
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0/Anticholesteremic Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 1339-63-5/Ubiquinone; 57-88-5/Cholesterol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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