Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of ≥50%

Urban Alehagen, Lina Benson, Magnus Edner, Ulf Dahlström, Lars H Lund

-The pathophysiology of heart failure with preserved ejection fraction (HFPEF) is poorly understood, but may involve a systemic pro-inflammatory state. Therefore statins might improve outcomes in patients with HFPREF defined as ≥50%. -Of 46,959 unique patients in the prospective Swedish Heart Failure Registry, 9,140 patients had HF and EF≥50% (age 77 ±11, 54.0 % women) and of these, 3,427 (37.5%) were treated with statins. Propensity scores for statin treatment were derived from 40 baseline variables. The association between statin use and primary (all-cause mortality) and secondary (separately, cardiovascular mortality and combined all-cause mortality or cardiovascular hospitalization) endpoints were assessed with Cox regressions in a population matched 1:1 based on age and propensity score. In the matched population, 1-year survival was 85.1% for statin-treated vs. 80.9% for untreated patients, hazard ratio (HR), 0.80 (95% confidence interval [CI], 0.72-0.89, p<0.001). Statins were also associated with reduced cardiovascular death (HR: 0.86, 95%CI 0.75-0.98, p: 0.026), and composite all-cause mortality or cardiovascular hospitalization (HR: 0.89, 95%CI 0.82-0.96, p:0.003). -In HF with ejection fraction ≥50%, the use of statins was associated with improved outcomes. The mechanisms should be evaluated and the effects tested in a randomized trial.