HMG CoA reductase inhibitors (
statins) have an established place in the treatment of
coronary artery disease. However, their role in the treatment of
heart failure (HF), including HF due to
coronary artery disease, has been controversial since beneficial as well as possible harmful effects may occur. Several recent studies lend support for a beneficial effect of the
statins in HF. These include: (i) post hoc subgroup analyses of prospective randomized clinical trials of
statin therapy among patients with stable
coronary artery disease where
statins reduce the incidence of new
HF; (ii) subgroup analysis of the evidence of
statin use in large HF trails with different medication and medical devices; (iii) retrospective observational studies of
statin use in HF; and (iv) prospective randomized clinical trials of
statins in non-ischemic. Beneficial effects include attenuation of
cardiac hypertrophy, improvement in endothelial function, anti-inflammatory effects, reduction in the activity of
matrix metalloproteinases, reduction in apoptosis, interference with
neurohormones, and improved homeostasis. However, there are also theoretical concerns about
statins in HF, and existing literature for their safety and efficacy in HF patients has been limited by the retrospective or observational nature of these analyses, examination of incompletely validated
surrogate endpoints and small prospective studies in subgroups of HF subjects. In contrast with the normal population, low concentrations of
LDL and total
cholesterol are associated with a worse prognosis in HF patients and a possible mechanism is reduction in
ubiquinone (
coenzyme Q10) levels, which is required for oxidative phosphorylation in cells. The safety aspect of these drugs in HF patients needs to be answered before
statins can be recommended as a routine
drug. For the moment there are several large-scale prospective outcome studies in HF which probably will give us more definitive answers.