Statin therapy for heart failure: to prescribe or not?

Since the publication of the first large randomised trial (1), the overwhelming body of evidence has demonstrated significant benefits of statins in patients with atherosclerotic cardiovascular disease (ASCVD). Despite strong recommendations of statins in ASCVD (2,3), controversy exists in patients with heart failure (HF). Although numerous observational studies have demonstrated favorable prognosis in HF patients treated with statins, two landmark randomized trials with rosuvastatin, GISSI-HF and CORONA studies (4,5), have not confirmed any marked reduction of all-cause mortality and non-fatal myocardial infarction (MI) and stroke in HF patients. Therefore, current guidelines do not explicitly recommend the use of statins in HF patients (1,2). However, a meta-analysis by Preiss and co-workers has further fuelled this debate (6).