Treating Diastolic Heart Failure With Statins

Diastolic heart failure (DHF) is a significant healthcare problem.1,2 Nearly 50% of all patients with chronic heart failure have DHF. Once hospitalized for heart failure, patients with DHF have a 50% chance of rehospitalization within 6 months. Patients with DHF have a 5% to 6% yearly mortality rate. It is estimated that treating patients with DHF costs in excess of $3.5 billion/year. Despite the significant impact that DHF has on heart failure incidence, prognosis, and cost, only 1 large randomized clinical trial has been completed that examined the treatment of patients with DHF, Candesartan cilexitil (Atacand) in Heart failure Assessment of Reduction Mortality and morbidity-Preserved (CHARM-Preserved).3See p 357 The poor clinical outcomes and the limited treatment options for patients with DHF underscore the importance and uniqueness of the Fukuta et al study published in this issue of Circulation .4 In this study, the authors conclude that treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may lower both mortality and morbidity rates in patients with DHF. Enthusiasm for and clinical application of the results of this study must be tempered by the fact that this represents a “preliminary report”; however, if proven effective in large randomized clinical trials, this therapeutic approach will represent an innovation and potentially a paradigm shift in the treatment of patients with DHF.This editorial will focus on addressing 4 questions: (1) Does hyperlipidemia contribute to the pathophysiology of DHF?; (2) Why would these authors believe that statin therapy would reduce morbidity and mortality in patients with DHF?; (3) Are their data sufficiently robust to justify the performance of more definitive studies?; and (4) Does this study provide insights that will help to develop a comprehensive management strategy for patients with DHF?It is generally agreed that patients with chronic heart failure can …