REVIEW – December 2008

Statins and heart failure


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A short overview of the latest publications on statins is given. More data have become available demonstrating that statins decrease mortality and morbidity in patients with cardiovascular disease, not the least among those with type 2 diabetes mellitus. New data support the viewpoint that more aggressive lipid lowering therapy results in better outcome. However, to achieve lower levels of LDL cholesterol, higher doses of statins are required, which may be problematic, as the side effects of statins tend to be doserelated. A combination of a lower dose of statin with ezetimibe helps overcome this difficulty but there remain some safety problems related to this combination. Although lowering of LDL cholesterol is the primary mechanism underlying the effects of statins, post hoc analysis of large intervention trials as well as experimental studies suggest that a part of the beneficial effects of statins is independent of their lipidlowering capacity, the so-called pleiotropic effects. However, in the light of new data, many issues regarding statin therapy remain unresolved and controversial. The greatest disappointment of the near past is that statins are not effective in chronic heart failure patients, especially in those with advanced heart failure. This finding emphasizes once more the importance of early use of statins in individuals disposed to have or already having coronary artery disease, the most frequent cause of chronic heart failure.