The effect of statins on mortality in heart failure with preserved ejection fraction: a meta-analysis of propensity score analyses

Background: Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. However, no pharmacological therapy has been shown to improve survival in HFpEF patients. Previous retrospective and prospective observational studies have examined the prognostic impact of hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) in patients with HFpEF. However, the results are inconsistent due to limited power with small sample sizes and/or lack of adjustment for known prognostic factors and differences in baseline characteristics between patients treated with and without statins. Methods: We aimed to conduct a meta-analysis of prospective observational studies examining the effect of statin therapy on mortality in HFpEF patients with the use of propensity score analysis. Results: A total of 4 studies with 5,536 patients (2,768 patients [50%] on statins; mean age, 65-77 years; male, 43-66%; coronary artery disease, 42-64%; hypertension, 61-82%; diabetes, 20-29%; follow-up duration, 12-36 months) were included in this meta-analysis. The pooled analysis showed that statin therapy was associated with reduced mortality (odds ratio [95% CI] = 0.690 [0.493-0.965], P = 0.030). Conclusion: Our meta-analysis suggests the potential mortality benefit of statins in HFpEF. Further prospective observational studies and randomized controlled trials should be planned to confirm our observed potential survival benefit of statins in HFpEF. (C) 2016 Elsevier Ireland Ltd. All rights reserved.