Estatinas en la Insuficiencia Cardiaca Fernando Civeira Hospital Universitario Miguel Servet ZARAGOZA

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Estatinas en la Insuficiencia CardiacaFernando
CiveiraHospital Universitario Miguel
ServetZARAGOZA
V JORNADAS ACTUALIZACIÓN EN INSUFICIENCIA
CARDIACA

• Zaragoza, 11 de noviembre 2009

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Efficacy and safety of cholesterol-lowering
treatment prospective meta-analysis of data from
90 056 participants in 14 randomised trials of
statins Cholesterol Treatment Trialists (CTT)
Collaborators. Lancet 20053661267
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Retrospective sub-group analysis of 4S trial
19 reduction
placebo
35
31.9
simvastatin
30
25.5
25
20
Mortality ()
28 reduction
15
9.2
10
6.6
5
0
n228
n184
n1995
n2037
Heart failure
No heart failure
Kjekshus J et al. J Card Fail 19973249254
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Heart Failure Hospitalizations in the Treating to
New Targets (TNT) Study
0.10
0.08
0.06
Proportion of patients experiencingCHF with
hospitalization
Hazard ratio 0.74 95 CI 0.59-0.94P0.012
atorvastatin 10 mg
0.04
atorvastatin 80 mg
0.02
0.00
0
12
24
36
48
60
72
Months
Number at risk Number at risk
ATV 10 mg 5006 4972 4877 4840 4791 4791 4746 4692 4645 4586 2451 514 0
ATV 80 mg 4995 4969 4937 4895 4861 4825 4778 4735 4687 4611 2453 483 0
Khush KK et al. Circulation 2007115576583
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Efectos pleitrópicos de las estatinas
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Efectos pleiótrópicos estatinas e insuficiencia
cardiaca

• Disminuyen estrés oxidativo
• Tienen propiedades antiinflamatorias
• Mejoran disfunción endotelial
• Angiogénesis
• Disminuyen trombosis
• Movilizan células progenitoras de médula ósea
• Alteran remodelado ventricular

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CORONA - Study Design
A Randomized, Double-Blind, Placebo-Controlled
Study with Rosuvastatin in Patients with Chronic
Symptomatic Systolic Heart Failure
Patients (n5011) Chronic ischaemic systolic
heart failure receiving optimal HF treatment
(diuretics, ACE inhibitors, ARBs, beta-blocker
therapy) Ejection fraction0.40 (NYHA class
III/IV)or 0.35 (NYHA class II) 60 years
End points Time to cardiovascular death,
non-fatal MI, non-fatal stroke Total mortality
rosuvastatin 10 mg (n2514)
placebo (n2497)
1 8 to 2
Visit Week
2 4 to 2
3 0
4 6
521 3 monthly
Final 3 y
Eligibility Optimal HF treatment instituted
Median follow-up 2.7 years
Placebo run-in
Kjekshus J et al. Eur J Heart Fail
200571059-1069
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CORONA - Secondary EndpointsTotal number of
hospitalizations
Placebo (n2,497)
4,074
Rosuvastatin 10 mg (n2,514)
4,000
3,694
3,000
2,464
No. hospitalisations
2,193
2,000
1,510
1,501
1,299
1,109
1,000
0
Heart failure
All cause
CV cause
Non-CV cause
p0.01
p0.007
plt0.001
Kjekshus J et al. N Eng J Med 2007 357 doi
10.1056/NEJMoa0706201
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Post hoc analysis of the number fatal/non-fatal
MI or stroke in the primary endpoint
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Hazard ratio 0.84 95 CI 0.70 to 1.00 p 0.05
Placebo
12
Rosuvastatin 10 mg
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Percent of patients with event
6
3
0
0
36
30
24
18
12
6
Months of follow-up
No. at risk Placebo 2497 2315 2156 2003 1851 1431
811 Rosuvastatin 2514 2345 2207 2068 1932 1484 855
Data on File
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Ensayos clínicos con estatinas
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Robinson JC, et al. JACC 2005461855-1862
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Conclusiones

• Las estatinas son fármacos excelentes en la
  prevención cardiovascular, incluida la prevención
  de insuficiencia cardiaca
• Las estatinas se toleran muy bien en pacientes
  con insuficiencia cardiaca
• Las estatinas no afectan la evolución de los
  pacientes con insuficiencia cardiaca II-IV, con
  independencia de su etiología
• Los potenciales efectos pleitrópicos de las
  estatinas parecen tener escaso impacto clínico en
  estos pacientes