Korean J Intern Med.  2014 Nov;29(6):754-763. 10.3904/kjim.2014.29.6.754.

Effects of intensive versus mild lipid lowering by statins in patients with ischemic congestive heart failure: Korean Pitavastatin Heart Failure (SAPHIRE) study

• Lee HY
• Cho HJ
• Kim HY
• Jeon HK
• Shin JH
• Kang SM
• Baek SH

• KMID: 2070133
• DOI: http://doi.org/10.3904/kjim.2014.29.6.754

Abstract

BACKGROUND/AIMS
This study was designed to evaluate the dose-effect relationship of statins in patients with ischemic congestive heart failure (CHF), since the role of statins in CHF remains unclear.
METHODS
The South koreAn Pitavastatin Heart FaIluRE (SAPHIRE) study was designed to randomize patients with ischemic CHF into daily treatments of 10 mg pravastatin or 4 mg pitavastatin.
RESULTS
The low density lipoprotein cholesterol level decreased by 30% in the pitavastatin group compared with 12% in the pravastatin (p < 0.05) group. Left ventricular systolic dimensions decreased significantly by 9% in the pitavastatin group and by 5% in the pravastatin group. Left ventricular ejection fraction (EF) improved significantly from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (16% vs. 11%) than that in the pravastatin group, no significant difference was observed between the groups (p = 0.386). Exercise capacity, evaluated by the 6-min walking test, improved significantly in the pravastatin group (p < 0.001), but no change was observed in the pitavastatin group (p = 0.371).
CONCLUSIONS
Very low dose/low potency pravastatin and high dose/high potency pitavastatin had a beneficial effect on cardiac reverse remodeling and improved systolic function in patients with ischemic CHF. However, only pravastatin significantly improved exercise capacity. These findings suggest that lowering cholesterol too much may not be beneficial for patients with CHF.

Keyword

Hydroxymethylglutaryl-CoA reductase inhibitors; Pitavastatin; Heart failure; Exercise capacity

MeSH Terms

Aged
Biological Markers/blood
Cholesterol, LDL/*blood
Down-Regulation
Dyslipidemias/blood/diagnosis/*drug therapy/epidemiology
Exercise Tolerance/drug effects
Female
Heart Failure/diagnosis/*drug therapy/epidemiology/physiopathology
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage/adverse effects
Male
Middle Aged
Myocardial Ischemia/diagnosis/*drug therapy/epidemiology/physiopathology
Pravastatin/*administration & dosage/adverse effects
Prospective Studies
Quinolines/*administration & dosage/adverse effects
Recovery of Function
Republic of Korea
Stroke Volume/drug effects
Time Factors
Treatment Outcome
Ventricular Function, Left/drug effects
Ventricular Remodeling/drug effects
Biological Markers
Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Pravastatin
Quinolines