The case for statin therapy in chronic heart failure

Both primary and secondary prevention studies have provided a wealth of evidence that statin therapy effectively reduces cardiovascular events. However, this general statement on the efficacy and safety of statin treatment has not been validated in patients with chronic heart failure (CHF). Recently, numerous statin trials have reported analysis on CHF parameters and numerous CHF trials have performed analysis on baseline statin use. In this article, we will review the currently available evidence from a pathophysiological as well as clinical perspective, building a case for and against the use of statins in CHF. From a pathophysiological perspective, we will discuss the known association of cholesterol and mortality, the ubiquinone, and the endotoxin-lipoprotein hypothesis. From a clinical perspective, we will discuss the observational studies, subgroup analysis of large randomized controlled trials, prospective randomized trials in CHF patients, and the future perspectives of the large European statin studies focussing on the statin therapy in CHF.