New study advocates for initiation of statins in primary prevention for heart failure with preserved ejection fraction

The researchers showed reduced all-cause mortality, major adverse cardiovascular events (MACE), and hospitalization in veterans having HFpEF without prevalent atherosclerotic cardiovascular disease (ASCVD), with new statin use. The findings were published online in JACC: Advances.

Heart failure with preserved ejection fraction, characterized by impaired cardiac relaxation and filling despite preserved systolic function, represents a significant clinical challenge with limited therapeutic options. While statins are prescribed widely for secondary prevention of cardiovascular disease, their utility in primary prevention strategies for HFpEF has been a subject of debate.

Statins are highly effective for the primary prevention of ASCVD and mortality. Data is limited on the benefit of statins in adults with HFpEF and without ASCVD. To fill this knowledge gap, Ariela R. Orkaby, VA Boston Healthcare System, Boston, Massachusetts, USA, and colleagues aimed to determine whether statins are associated with a lower mortality and MACE risk in HFpEF.

For this purpose, the researchers collected Veterans Health Administration data from 2002 to 2016, linked to Medicare and Medicaid claims and pharmaceutical data. Patients had a new diagnosis of HFpEF and no known ASCVD or prior statin use at baseline.

Cox proportional hazards models were fit to assess the association of new statin use with outcomes (MACE and all-cause mortality). Propensity score overlap weighting (PSW) was used to balance baseline characteristics.

The following were the key findings of the study:

• Among 7,970 Veterans, 47% initiated a statin over a mean 6.0-year follow-up. At HFpEF diagnosis, the mean age was 69 ± 12 years, 96% were male, and the mean EF was 60% ± 6%.
• Before PSW, statin users were younger with more prevalent metabolic syndrome, arthritis, and other chronic conditions. All characteristics were balanced after PSW.
• There were 5,314 deaths and 4,859 MACE events.
• After PSW, the hazard for all-cause mortality for statin users vs nonusers was 22% lower (HR: 0.78).
• The HR for MACE was 0.79, 0.69 for all-cause hospitalization, and 0.72 for HF hospitalization.

In conclusion, among Veterans with HFpEF without known cardiovascular disease, statins were associated with reduced all-cause mortality and MACE. Confirming these findings in a future randomized controlled trial is necessary.

Reference:

Orkaby AR, Goyal P, Charest B, et al. Initiation of statins for primary prevention in heart failure with preserved ejection fraction. JACC Adv. 2024;3:100869.