People with heart failure and normal cholesterol levels may benefit from treatment with a statin agent even though they do not have coronary artery disease, according to an article in the July 29th rapid access issue of Circulation.

“This is the first prospective study to show that statins have beneficial effects in heart failure in the absence of coronary artery disease or high blood cholesterol,” said senior author James K. Liao, M.D. “This was a surprising finding in that the benefits occur after only 14 weeks of treatment and with a very low dose of the drug.”

“Because statins improve blood vessel function and suppress the inflammatory process, we believed that statins might improve heart function and the neurohormonal imbalance found in most forms of chronic heart failure,” explained Liao.

In order to test their hypothesis on statin benefit apart from effects on cholesterol, Koichi Node, MD, PhD, study lead author, and colleagues studied Japanese patients with idiopathic dilated cardiomyopathy. With these selection criteria, the group of 51 people (ages 53 to 55 years) were otherwise healthy people, many of whom qualified for heart transplantation. Liao said that there are about 550,000 new cases of heart failure per year in Japan, with about 15 percent non-ischemic in origin.

Participants were randomized to either simvastatin 5 mg for 4 weeks followed by 10 mg for 10 weeks or placebo. As a comparison, the standard U.S. dose for cholesterol-lowering effect is 40 mg daily. Because of the small dose, average total cholesterol in the study participants fell only modestly for the statin group, from 221 mg/dL to 201 mg/dL.

Patients treated with simvastatin achieved a better New York Heart Association functional level (from 2.39 to 2.04) than those on placebo (from 2.36 to 2.32). In the statin group, 39.1 percent of patients had an improved functional class, 56.6 percent remained unchanged, and 4.3 percent worsened. In the placebo group, only 16 percent improved, 72 percent remained the same, and 12 percent deteriorated. The left ventricular ejection fraction rose from 34 percent to 41 percent in the statin group, but stayed the same in the placebo group.

The improved cardiac function observed in the current study was in addition to improvement already observed with beta blockers and angiotensin-converting enzyme inhibitors. “This is quite remarkable for this disease,” Liao stated. “These improvements are significant given that these patients had only moderate disease and were treated for only 14 weeks. This opens up a new treatment strategy for patients with heart failure regardless of their cholesterol levels.”

However, the authors caution that larger studies with hard endpoints are needed before statins can be recommended to treat patients with chronic heart failure of a non-ischemic origin.