Author + information
- Neil L. Coplan, MD, FACC⁎ ( and )
- Mark Ramos, MD
- ↵⁎Division of Cardiovascular Medicine, Lenox Hill Hospital, 100 East 77th Street, New York, New York 10021
Goldberger et al. (1), authors of “Effects of Statin Therapy on Arrhythmic Events and Survival in Patients with Nonischemic Dilated Cardiomyopathy”, note that the data “strongly suggests that statins may improve mortality in patients with nonischemic cardiomyopathies.” Although an association has been demonstrated between statin use and survival, it will take more data before an effect can be attributed to statin therapy. The fact that there is no significant difference in the number of appropriate implantable cardioverter-defibrillator (ICD) shocks between patients treated with statins and those not treated with statins does not support the concept that statins have a pleiotropic antiarrhythmic effect.
Another factor that needs to be considered is whether statin therapy in this study is just a marker for a better prognosis. Although data are not presented, it is presumed that patients on statin therapy had higher cholesterol. Studies (2,3) have shown that higher serum total cholesterol is independently associated with a better prognosis in patients with heart failure. Patients without statin therapy may have had poor nutrition or some other type of medical problem related to poor survival (4). It would be interesting to know the albumin levels or other measures of general nutrition in the statin and nonstatin groups.
The investigators (1) note in the limitations section of their study that it is highly implausible to assume that hypercholesterolemia selects a patient population at markedly lower risk. Rather than dismissing this relationship, the inverse relationship between heart failure mortality and cholesterol level should be considered in any future study of possible statin effect.
- American College of Cardiology Foundation
- Goldberger J.J.,
- Subacius H.,
- Schaechter A.,
- et al.
- Rauchhaus M.,
- Clark A.L.,
- Doehner W.,
- et al.