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 Collaborating trialists provided unpublished data from adverse event reports.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 metaanalyses.
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).Theeffect of statinson first non-fatalHF hospitalizationwas similarwhether thiswaspreceded
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, statinsmodestly reduced the risksof non-fatalHF hospitalization and acompositeof nonfatal
HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not.