The Effects on Mortality of Statin Therapy in Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): An Updated Systematic Review and Meta-Analysis

Statins have demonstrated benefits in improving outcomes for patients with heart failure with reduced ejection fraction (HFrEF). However, their effects on patients with heart failure with preserved ejection fraction (HFpEF) remain unclear. This study aimed to perform an updated systematic review and propensity score (PS) meta-analysis comparing the impact of statin therapy versus no statin therapy in this population. Coan A presented a session held at the American Heart Association (AHA) from 16^th to 18^th November 2024 in Chicago, Illinoi.

A comprehensive search was conducted in PubMed, Embase, and Cochrane Library databases to identify studies evaluating the effects of statins in HFpEF patients. The primary outcome was all-cause mortality, while secondary outcomes included cardiovascular (CV) mortality and heart failure (HF) hospitalization. A subgroup analysis was performed for the primary outcome, distinguishing studies using PS adjustments from those without baseline covariate adjustments.

Meta-analysis included 17 studies with a total of 43,911 HFpEF patients, of whom 19,142 (43.59%) were on statin therapy. The mean age was 66.95 years, with an average follow-up of 3.08 years. Statin therapy was significantly associated with reductions in all-cause mortality (HR 0.68; 95% CI 0.62–0.76; p<0.01) and HF hospitalization (HR 0.75; 95% CI 0.69–0.81; p<0.01). However, there was no significant impact on CV mortality (HR 0.84; 95% CI 0.70–1.00; p=0.05). Subgroup analysis confirmed the benefits of statins on all-cause mortality in PS-adjusted studies (HR 0.78; 95% CI 0.74–0.83; p<0.01), with a significant difference (p<0.01) between PS and non-PS results.

This meta-analysis highlights that statin therapy in HFpEF is associated with reduced all-cause mortality and HF hospitalization, with findings reinforced by PS analysis. However, the benefits of statins do not extend to CV mortality in this patient population.