A Striking Win for Statins

GLP-1 agonists and SGLT2 inhibitors seem to be the wonder drugs for the 21st century. However, statins were clearly the wonder drugs of the 20th century. Like the GLP-1 agonists and SGLT2 inhibitors, statins could do no wrong. Nearly every large clinical trial was positive, and benefits in reducing the risks of major adverse cardiac events (MACE) and cardiovascular death (CVD) were consistent across many patient populations.

Heart failure (HF) with preserved ejection fraction (HFpEF) continues to be a disease with limited treatment options. Recently, SGLT2 inhibitors emerged as an effective treatment option, but outside of these medications, patients with HFpEF continue to suffer an unacceptably high number of adverse cardiovascular events.

In this installment of Talking Therapeutics, we explore a new paper outlining the potential benefit of statins on key outcomes in patients with HFpEF.

Talking Point: Exciting Benefits Noted

In a recent study, 7970 veterans with HFpEF and no history a clinical heart/vascular disease or prior statin use were identified from a large US database. Of these, 3759 initiated a statin during the 6-year follow-up period.

The authors found that use of a statin was associated with a 22% reduction in all-cause mortality (HR, 0.78; 95% CI, 0.73-0.83) and a 21% reduction in MACE (HR, 0.79; 95% CI, 0.74-0.84). Statin use also reduced the risk of all-cause hospitalizations (RR, 0.69; 95% CI, 0.60-0.80) and HF hospitalizations (RR, 0.72; 95% CI, 0.59-0.88).

Talking Point: This is a No-Brainer

While these data are retrospective and hence, they cannot provide causation, it would be hard for me to recommend against starting a statin in patients with HFpEF and no history of CVD. These medications are very cheap, have little risk of serious side effects, and are widely available. Based on this trial, it would seem highly likely that a large, randomized trial evaluating statins in patients with HFpEF will be designed and executed.