Systemic inflammation, statin therapy, and clinical outcomes in heart failure: a territory-wide population-based cohort study
A Cai, W L Gu, K H YiuAbstract
Background
Inflammation is increasingly recognized as an important modifier of prognosis in heart failure (HF). However, whether the association between statin therapy and outcomes varies by inflammatory risk and treatment duration remains uncertain.
Purpose
To evaluate the association between statin therapy and clinical outcomes in patients with newly diagnosed HF, and to assess whether baseline C-reactive protein (CRP) levels and statin treatment duration modify these associations.
Methods
We performed a territory-wide, population-based cohort study using the electronic health record (EHR) database of the Hong Kong Hospital Authority. Patients hospitalized with newly diagnosed HF between 2014 and 2018 were included. Statin users were defined as patients receiving statins for ≥90 consecutive days after HF diagnosis and were propensity score matched 1:1 to non-users. Co-primary outcomes were (1) cardiovascular (CV) mortality or hospitalization for HF (HHF) and (2) all-cause mortality. Analyses were stratified by baseline CRP (<2 mg/L vs ≥2 mg/L) and by statin treatment duration.
Results
Among 25,786 eligible patients (mean age 77.9 years; 48.6% men), 40% had elevated CRP (≥2 mg/L), which was associated with a worse clinical profile and poorer outcomes. In the propensity score-matched cohort (n=6,780), cumulative incidence of primary outcomes was lower in statin users versus nonusers in the normal (Figure 1 Pane A-B) and elevated (Figure 1 Panel C-D) CRP groups. Statin therapy was associated with lower risk of CV mortality or HHF in both the normal CRP group (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.63-0.75) and the elevated CRP group (HR 0.68, 95% CI 0.60-0.76). Statin therapy was also associated with lower all-cause mortality in both CRP strata (normal CRP: HR 0.45, 95% CI 0.41-0.50; elevated CRP: HR 0.43, 95% CI 0.38-0.48). Among patients with elevated CRP, longer statin treatment duration was associated with progressively greater reductions in CV mortality or HHF.
Conclusions
In patients with newly diagnosed HF, statin therapy was associated with improved cardiovascular and survival outcomes across inflammatory risk strata. In patients with elevated CRP, longer treatment duration was associated with greater benefit. These findings support further evaluation in pragmatic, EHR-enabled randomized trials.Figure 1