Statins in Heart Failure: More Questions Than Answers

• If statins are beneficial, is it due to lipid-lowering or “pleiotropic” effects?

• Is the benefit similar in ischemic vs. nonischemic heart failure?

• Is low cholesterol associated with poor outcomes in heart failure?

• Could statins actually be detrimental?

• Does the dose of statins matter? (No effect in HF benefit in CARE, PROSPER, ALLHAT, ASCOT)

• Well-proven benefit of statins in reducing CV events:

• Primary prevention – WOSCOPS, AFCAPS/TexCAPs, ALLHAT

• Secondary prevention – 4S, CARE.

• Intensive statin therapy may be superior to moderate statin therapy

• PROVE IT-TIMI 22, TNT, IDEAL, A2Z.