The Effects of Atorvastatin (10 mg) on Systemic Inflammation in Heart Failure

• Published in: The American journal of cardiology Vol. 96; no. 12; pp. 1699 - 1704
• Main Authors: Mozaffarian, Dariush, Minami, Elina, Letterer, Rebecca A., Lawler, Richard L., McDonald, George B., Levy, Wayne C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.12.2005; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Atorvastatin Calcium; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - drug effects; C-Reactive Protein - metabolism; Cardiology. Vascular system; Clinical trials; Cross-Over Studies; Double-Blind Method; Drug therapy; Endothelin-1 - blood; Endothelin-1 - drug effects; Enzyme-Linked Immunosorbent Assay; Female; Heart; Heart attacks; Heart failure; Heart Failure - blood; Heart Failure - drug therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Inflammation - blood; Male; Medical sciences; Middle Aged; Pyrroles - therapeutic use; Receptors, Tumor Necrosis Factor, Type I - blood; Receptors, Tumor Necrosis Factor, Type I - drug effects; Statins; Treatment Outcome; Heart failure; Heart disease; Atorvastatin; Cardiovascular disease; Inflammation; Systemic; Circulatory system; Disseminated; Cardiology; Phlebology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2005.07.092

In observational studies, statins are associated with lower mortality in patients with heart failure (HF), including those with nonischemic HF. Such benefits could be related to anti-inflammatory effects; however, the effects of statins on systemic inflammation in HF are not well-established. We conducted a 16-week, single-center, randomized, double-blind, placebo-controlled, crossover clinical trial of the effects of atorvastatin 10 mg/day on concentrations of systemic inflammatory markers in 22 patients with HF (including 20 with nonischemic HF) with New York Heart Association class II or III symptoms and left ventricular ejection fraction of <40%. The absolute and percentage of changes in inflammatory marker levels were evaluated using analysis of variance. Statin treatment reduced the concentrations of soluble tumor necrosis factor receptor-1 by 132 pg/ml (p = 0.04) and 8% (p = 0.056), C-reactive protein by 1.6 mg/L (p = 0.006) and 37% (p = 0.0002), and, after adjustment for treatment order, endothelin-1 by 0.21 pg/ml (p = 0.007) and 17% (p = 0.01). In post hoc analyses, the reduction in tumor necrosis factor receptor-1 levels was highest among patients with elevated levels at baseline (at or higher than the median of 1,055 pg/ml, p interaction = 0.001), among whom statin therapy reduced the levels by 306 pg/ml (p <0.001) and 22% (p <0.001). Statin treatment did not significantly affect the levels of other inflammatory markers, including interleukin-6 and brain natriuretic peptide. In conclusion, short-term atorvastatin therapy reduced the levels of several important inflammatory markers in patients with HF.