Class effects of statins in elderly patients with congestive heart failure: A population-based analysis

Rinfret, Stéphane; Behlouli, Hassan; Eisenberg, Mark J.; Humphries, Karin; Tu, Jack V.; Pilote, Louise

doi:10.1016/j.ahj.2007.09.004

« Previous Next »American Heart Journal
Volume 155, Issue 2 , Pages 316-323, February 2008

Class effects of statins in elderly patients with congestive heart failure: A population-based analysis

Stéphane Rinfret, MD, MSc
- Division of Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
Hassan Behlouli, PhD
- Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, Canada
Mark J. Eisenberg, MD, MPH
- Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
- Division of Clinical Epidemiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
Karin Humphries, DSc
- Division of Cardiology, University of British Columbia and Centre for Health Evaluation and Outcome Science, Vancouver, British Columbia
Jack V. Tu, MD, PhD
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Louise Pilote, MD, MPH, PhD
- Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, Canada
- Division of Internal Medicine, McGill University Health Center, McGill University, Montreal, Canada
- Reprint requests: Louise Pilote, MD, MPH, PhD, Division of Internal Medicine and Clinical Epidemiology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4.

Received 20 April 2007; accepted 13 September 2007. published online 26 October 2007.

Background

Long-term treatment with statins reduces mortality in patients with congestive heart failure (CHF). Whether statin agents exert a class effect is unknown.

Methods

We analyzed long-term mortality in Canadian patients aged ≥65 years who were discharged from hospital with a diagnosis of CHF from January 1998 to December 2002. Administrative data from Quebec, Ontario, and British Columbia were merged. We compared patients prescribed with atorvastatin, simvastatin, pravastatin, and lovastatin.

Results

A total of 15368 patients hospitalized with a diagnosis of CHF fulfilled the inclusion criteria for this study. In this final dataset, 6670 (43.4%) filled a prescription for atorvastatin, 4261 (27.7%) for simvastatin, 3209 (20.9%) for pravastatin, and 1228 (8.0%) for lovastatin. Clinical characteristics and proportion of days covered with a statin prescription were similar across groups. Drug dosages were relatively low, with 82% of patients who received the agent at a dose of ≤20 mg. Although controlling for time-dependent covariates representing current use and dosage, as well as for age, sex, coronary artery disease, and several other comorbidities, treatment with pravastatin (adjusted hazards ratio [HR] 0.94, 95% CI 0.83-1.07), lovastatin (adjusted HR 1.02, 95% CI 0.88-1.17), or simvastatin (adjusted HR 0.92, 95% CI 0.83-1.01) had a similar effectiveness to prevent mortality compared to atorvastatin (reference in this analysis) in this population with CHF. Time-dependent exposure to a statin was highly protective against mortality.

Conclusions

Statins exert a class effect in patients with CHF, when used at a relatively low dose. The favorable effects appear largely independent of drug dosage.