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Statine e scompenso cardiaco. Una meta-analisi

Molti degli studi controllati con statine hanno pubblicato dati sullo scompenso cardiaco. Alcuni hanno dimostrato un effetto positivo per riduzione della necessità di ricovero ospedaliero e solo uno ha documentato anche una riduzione della mortalità per scompenso. Nel complesso da questi studi non si sono ricavate conclusioni certe. La meta-analisi di Preiss e coll. condotta su oltre 132.000 pazienti inclusi in 17 studi, dimostra che la terapia con statine ha comportato una modesta, ma significativa diminuzione degli episodi di scompenso cardiaco sia nei pazienti in prevenzione primaria che secondaria. Il rischio di ospedalizzazione e di morte per scompenso era più basso di circa il 10% ed era simile nei pazienti con o senza storia di cardiopatia ischemica.

The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials.

Preiss D, Campbell RT, Murray HM, Ford I, Packard CJ, Sattar N, Rahimi K, Colhoun HM, Waters DD, LaRosa JC, Amarenco P, Pedersen TR, Tikkanen MJ, Koren MJ, Poulter NR, Sever PS, Ridker PM, MacFadyen JG, Solomon SD, Davis BR, Simpson LM, Nakamura H, Mizuno K, Marfisi RM, Marchioli R, Tognoni G, Athyros VG, Ray KK, Gotto AM, Clearfield MB, Downs JR, McMurray JJ

Eur Heart J 2015;36:1536-1546

AIMS: The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events.
METHODS AND RESULTS: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first non-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring <30 days after within-trial myocardial infarction (MI) were excluded. We calculated risk ratios (RR) with fixed-effects meta-analyses. In up to 17 trials with 132 538 participants conducted over 4.3 [weighted standard deviation (SD) 1.4] years, statin therapy reduced LDL-cholesterol by 0.97 mmol/L (weighted SD 0.38 mmol/L). Statins reduced the numbers of patients experiencing non-fatal HF hospitalization (1344/66 238 vs. 1498/66 330; RR 0.90, 95% confidence interval, CI 0.84-0.97) and the composite HF outcome (1234/57 734 vs. 1344/57 836; RR 0.92, 95% CI 0.85-0.99) but not HF death (213/57 734 vs. 220/57 836; RR 0.97, 95% CI 0.80-1.17). The effect of statins on first non-fatal HF hospitalization was similar whether this was preceded by MI (RR 0.87, 95% CI 0.68-1.11) or not (RR 0.91, 95% CI 0.84-0.98).
CONCLUSION: In primary- and secondary-prevention trials, statins modestly reduced the risks of non-fatal HF hospitalization and a composite of non-fatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not.

Eur Heart J 2015;36:1536-1546