Effects of Lipophilic Statins for Heart Failure: A Meta-analysis of 13 Randomised Controlled Trials

Background The effects of lipophilic statins in heart failure (HF) were controversial. The goal of the present study was to systematically review all randomised controlled trials evaluating the effects of lipophilic statins in patients with HF. Methods We performed a comprehensive literature search to identify eligible trials that prospectively randomised patients with HF to lipophilic statins or control. Primary end points were all-cause mortality, cardiovascular mortality, hospitalisation for worsening HF, left ventricular ejection fraction (LVEF), and low-density lipoprotein cholesterol. Risk ratios (RRs) and Weighted mean differences (WMDs) were calculated using fixed-effects models or random-effects models. Results A total of 13 randomised trials with 1,532 subjects were included in this analysis. Ten trials randomised patients to atorvastatin, two to simvastatin, and one to pitavastatin. Overall, lipophilic statins significantly decreased all-cause mortality (RR 0.53, P < 0.001), cardiovascular mortality (RR 0.66, P = 0.04), and hospitalisation for worsening HF (RR 0.60, P < 0.001). Subgroup analyses showed that the effects of lipophilic statins in HF were not modified by age, baseline LVEF, and cause of HF. In addition, patients randomised to lipophilic statins had a significant increase in LVEF (WMD 3.91%, P < 0.001) and decrease in low-density lipoprotein cholesterol (WMD 0.90 mmol/L, P < 0.001). Conclusions It appears that further studies are needed to determine if lipophilic statins are beneficial for HF patients.