Lipophilic statin versus hydrophilic statin treatment on cardiac function and inflammation in heart failure: A systematic review and an adjusted indirect comparison meta-analysis

Abstract

Introduction: Statins reduce morbidity and mortality in prevention studies. Statins improve cardiac function and reduce inflammation in heart failure (HF). It is unclear whether statins as a class or subtype (lipophilic or hydrophilic) improve outcomes in HF. Sufficiently powered comparative trials between statin subtypes in HF are unavailable. We conducted an adjusted indirect comparison meta-analysis between lipophilic and hydrophilic statins on outcomes in HF. The outcomes are left ventricular ejection fraction (LVEF), Brain natriuretic peptide (BNP), C-reactive protein (CRP) and Interluekin-6 (IL-6).

Method: We conducted a search of PubMed, EMBASE and Cochrane databases until October 2014 for randomised control trials (RCTs) statins versus placebo in HF.

Studies and their respective abstracted information were dichotomised into group of statin subtype evaluated and analysed separately. Generic-inverse random effects approach was used to pool outcomes. With the pooled estimates, we performed adjusted indirect comparisons for each outcome. Data from 11, 450 patients from 23 trials were analysed.

Results: Lipophilic statins were superior to placebo whereas hydrophilic statins were comparable to placebo in all reported outcomes. Lipophilic statins were comparable to hydrophilic statins in all reported outcomes of cardiac function (LVEF (MD, 0.68; 95% CI, -3.72-5.08; SOE low) and BNP (MD, 206.73; 95% CI, 58.91-354.56; SOE low) and inflammation (CRP (MD, -1.30; 95% CI, -3.90-1.31; SOE low) and IL-6 (MD, -1.93; 95% CI, -4.03-0.18; SOE low) in the comparison meta-analysis.

Conclusion: Lipophilic statins are comparable to hydrophilic statins in HF. This meta-analysis provides preliminary evidence for comparison in HF till data from head to head comparisons are available.