Source: DGNews  |  Posted 2 years ago

By Betty S. Riggs

SAN DIEGO -- November 9, 2009 -- Statins appear to reduce appropriate implantable cardioverter-defibrillator (ICD) shocks and all-cause mortality in selected patients with heart failure, researchers stated here on November 4 at CHEST 2009, the annual meeting of the American College of Chest Physicians.

Harit Desai, MD, Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York, and colleagues evaluated 209 patients with heart failure who were treated with combined cardiac resynchronisation therapy (CRT) and ICDs.

Every 3 months, patients were evaluated, and the CRT-ICD was interrogated to determine if any shocks occurred and if the shocks were appropriate. All-cause mortality data was obtained from the Social Security Death Index.

Of the patients, 121 (58%) were treated with statins, and 88 (42%) were not. Mean follow-up was 35 +- 20 months for patients on statins and 32 +- 19 months for patients not on statins.

Baseline characteristics were similar between groups with the exception that all patients treated with statins had the diagnosis of dyslipidaemia compared with 68% of patients not treated with statins (P < .0001), and 75% of patients treated with statins were also treated with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) compared with 63% of patients not treated with statins (P = .048).

Appropriate ICD shocks occurred in 22 of 121 patients (18%) on statins versus 30 of 88 patients (34%) not on statins (P = .009). Deaths occurred in 3 of 121 patients (2%) on statins versus 9 of 88 patients (10%) not on statins (P = .017).

Stepwise Cox regression analysis using the variables of gender, age, use of statins, beta blockers, ACEs or ARBs, ischaemic heart disease, nonischaemic heart disease, smoking, dyslipidaemia, hypertension, diabetes, and left ventricular ejection fraction (LVEF) showed that significant independent prognostic factors for appropriate ICD shocks were use of statins (risk ratio [RR] = 0.46; P = .008), smoking (RR = 3.5; P = .0006), and diabetes (RR = 0.34; P = .031).

Significant independent prognostic factors for the time to all-cause mortality were use of statins (RR = 0.05; P = .0004), use of digoxin (RR = 4.2; P = .027), hypertension (RR = 14.2; P = .016), diabetes (RR = 4.3; P = .031), and LVEF (RR = 1.1; P = .006).

According to Dr. Desai, patients with heart failure treated with the combination of CRT and ICDs should be treated with statins to reduce all-cause mortality and appropriate ICD shocks.

Presentation title: Statins Reduce Appropriate Implantable Cardioverter-Defibrillator Shocks and Mortality in Patients With Heart Failure Treated With Combined Cardiac Resynchronization Therapy and Implantable Cardioverter-Defibrillators