Heart failure deaths in elderly not reduced by statin
Silvia Jansen/iStockpoto
Elderly patients with moderate to severe heart failure taking rosuvastatin were less likely to require hospital admission |
Rosuvastatin reduces cardiovascular hospital admissions but has little
impact on reducing mortality in elderly patients with moderate to severe
heart failure, according to the first major study to investigate statins
in this group of patients.
The CORONA study randomised 5,011 patients aged 60 and over with ischaemic,
systolic heart failure (New York Heart Association class II, III or IV)
to rosuvastatin (10mg daily) or placebo.
Results, reported at the American
Heart Association Scientific Sessions held in Orlando, Florida, this week, and published online in The
New England Journal of Medicine (5 November), showed
a 45 per cent reduction in LDL-cholesterol in the rosuvastatin-treated
group.
There were slightly fewer deaths from cardiovascular causes, non-fatal
myocardial infarctions and non-fatal strokes in patients treated with
rosuvastatin (692 patients) compared with the placebo group during follow-up
of nearly three years (732) but this did not reach statistical significance
(hazard ratio 0.92, P=0.12). However, fewer patients randomised to rosuvastatin
were admitted to hospital for cardiovascular causes (2,193) than were
those given placebo (2,564; P<0.001).
One of the researchers, Ake Hjalmarson, from Salgrenska University Hospital,
Goteborg University, Sweden, said: “Despite having favourable effects
on lipids, rosuvastatin did not reduce the primary outcome or the number
of deaths in older patients in this group of very sick patients with
severe systolic heart failure. However, the drug did reduce the number
of cardiovascular hospitalisations.”
Professor Hjalmarson said
that the patients may have been too ill to show a reduction in mortality,
suggesting that sudden death in patients with heart failure could be
caused by primary arrhythmias. In other groups of patients, statins probably
reduce sudden death by preventing the rupture of coronary plaques.
He added that the safety data from the study were reassuring, with muscle-related
symptoms being no more common in the rosuvastatin group than in patients given
placebo.
Helen Williams, specialist cardiovascular pharmacist, King’s College Hospital
and Lambeth and Southwark Primary Care Trusts, London, commented: “The
study results were disappointing because we still don’t know whether statin
treatment reduces mortality in patients with heart failure. The assumption is
that there should be a benefit in patients with ischaemic disease, but the results
did not show that.”
She concluded: “Patients with class III or IV
heart failure have a poor prognosis, and won’t generally live long enough
to benefit from statin treatment. But those with less severe heart failure — class
I or II — may benefit.”
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The
Pharmaceutical Journal
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