Effects of statins on functional capacity and cardiac remodeling in patients with heart failure and preserved ejection fraction: a randomized open-label pilot trial.

BACKGROUND

Systemic inflammation is an essential pathophysiological factor of heart failure with preserved ejection fraction (HFpEF) that supports the use of statins. The purpose of the study was to determine the effects of statin therapy with atorvastatin or rosuvastatin on functional capacity, cardiac remodeling, profibrotic and inflammatory biomarkers in patients with HFpEF. Since lipophilic and hydrophilic statins may exert different effects on HF, we also compared the effects of lipophilic atorvastatin vs. hydrophilic rosuvastatin.

METHODS

We enrolled 59 patients with HFpEF who had no history of statin use or had not received statins for 6 months. Participants were randomly assigned to receive atorvastatin (20-80 mg a day, n = 30) or rosuvastatin (10-40 mg a day, n = 29) for 6 months. Echocardiography, 6 min walk distance (6MWTD), biomarkers of inflammation (hsCRP and MCP-1), and extracellular matrix homeostasis (PICP and sST2) were analyzed at baseline and after 6 months.

RESULTS

After 6 months of therapy, atorvastatin was associated with a greater increase in 6MWTD than rosuvastatin, but both statin groups showed comparable improvements in NYHA functional class and bicycle exercise duration. There were comparable decreases in E/e' ratio and left atrial (LA) volume index, as well as comparable improvements in diastolic (e' velocity enhancement on exercise) and chronotropic (heart rate enhancement on exercise) reserves in both statin groups. Atorvastatin was superior to rosuvastatin in modifying LA reserve (reservoir strain enhancement on exercise). A significant decrease in blood levels of all biomarkers was observed in the atorvastatin group but not in the rosuvastatin group. Rosuvastatin was associated with a reduction in hsCRP and MCP-1 only in subgroups of patients with baseline values above the median.

CONCLUSIONS

In HFpEF, statin therapy appears to be associated with improved functional capacity, possibly by reducing LV filling pressure and favoring cardiac remodeling. Atorvastatin may provide some additional benefits compared with rosuvastatin.

CLINICAL TRIAL REGISTRATION: https://rosrid.ru, identifier AAAA-A18-118022290061-2.