Abstract 4145287: The effects on mortality of statin therapy in patients with heart failure with preserved ejection fraction (HFpEF): An updated systematic review and meta-analysis

BACKGOUND: Statins have shown benefits in the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). However, the effects of statin in patients with heart failure with preserved ejection fraction (HFpEf) remains unclear. Therefore, we aim to perform an updated systematic review and propensity scores (PS) meta-analysis comparing statin with no statin therapy in this population. METHODS: We searched in PubMed, Embase, and Cochrane Library databases for studies examining the effect of statin use in patients with HFpEF. The primary outcome was (1) all-cause mortality, with secondary outcomes being (1) cardiovascular (CV) mortality and (3) heart failure (HF) hospitalization. We also performed a subgroup analysis for the primary outcome, comparing studies that used PS and studies that did not adjust the baseline covariates. RESULTS: We included in this meta-analysis a total of 17 studies. Our study encompassed 43,911 patients with HPpEF, of whom 19,142 (43.59%) received statin therapy. The mean age was 66.95 years, with a mean follow-up of 3.08 years. In the pooled analysis, statin was significantly associated with reduced 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; Fig.1). However, our findings shows no significant change in CV mortality in the statin group (HR 0.84; 95%CI 0.70-1.00; p=0.05; Fig.2A). A subgroup analysis for the primary endpoint reported consistency in the benefits of statin group in patients with HFpEF (HR 0.78; 95%CI 0.74-0.83; p<0.01; Fig.2B) after adjusting the covariates using PS. Moreover, there was a significant difference (p<0.01) between the PS and non-PS results. CONCLUSION: In this updated meta-analysis of patients with HFpEF, statin therapy was associated with decreased all-cause mortality and HF hospitalization. Moreover, this finding was confirmed in a subgroup analysis of PS data. However, these benefits do not translate into CV mortality.