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Statins May Worsen Fatigue in Heart Failure Patients

But no one's suggesting the drugs should be stopped

TUESDAY, Nov. 3 (HealthDay News) -- Statins may boost the risk of fatigue and shortness of breath in some patients with heart failure, a new study suggests. But a second report found the cholesterol-reducing drugs reduce the risk of clots in those with cardiovascular disease, and experts think the benefits outweigh the risks.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California at Los Angeles, said patients shouldn't reconsider their use of the statins based on the results of the small U.S. study.

"Patients with heart failure who have an indication for statin therapy, such as coronary artery disease or diabetes, should remain on physician-prescribed statin therapy," Fonarow said.

At issue is treatment for heart failure, a condition that occurs when the heart fails to beat properly. An estimated 5.7 million people in the United States suffer from heart failure, which can cause fatigue, shortness of breath and fluid build-up in the lungs and legs.

"Approximately two-thirds of patients with heart failure have coronary artery disease," Fonarow said. "In these patients, statins, while not improving overall survival, have been shown to lower the risk of a cardiovascular event and decrease the likelihood of being hospitalized. In patients with heart failure but without vascular disease, neither benefit nor harm has been demonstrated in clinical trials of statin therapy."

Researchers at Northeastern University and Massachusetts General Hospital looked at the medical records of 136 patients with heart failure. They wanted to see how statin use, mainly of the drug atorvastatin (Lipitor), affected two types of heart failure -- systolic and diastolic.

Fonarow explained that the heart fails to contract normally in people with systolic heart failure. In those with diastolic heart failure, the heart may not relax properly or be abnormally stiff, he said.

The study findings were to be released this week at the American College of Chest Physicians annual meeting, in San Diego.

Those who had diastolic heart failure and took a cholesterol drug had almost half as much exercise tolerance as those with the condition who didn't take the drugs, the researchers found.

"Some patients with diastolic heart failure may be more prone to the adverse effect of statins on muscle. It may be that patients with particular preexisting factors will experience unfavorable results from statin therapy, including exercise intolerance, dyspnea [shortness of breath], and fatigue," study author Lawrence P. Cahalin, a researcher at Northeastern University, said in a statement.

"Not all statins are alike, and not all patients are alike. Some statins are stronger than others and are likely to act differently, given particular patient characteristics, and produce different degrees of wanted and unwanted effects," Cahalin said. "In our continuing study, we hope to identify patient characteristics that are associated with favorable and less than favorable results from statin therapy."

For now, Cahalin said tests are in order if heart failure patients taking statins suffer from fatigue, shortness of breath and inability to exercise for very long.

In another study to be released at the meeting, researchers report that statins may help prevent blood clots in people with cardiovascular disease.

Previous research has linked atherosclerosis, a condition in which fatty material builds up along artery walls, and venous thrombosis (VTE). Researchers from Albert Einstein Medical Center in Philadelphia, who were investigating the association between statin use and incidence of VTE, reviewed data on 593 patients who were hospitalized for heart attack or ischemic stroke.

"In our study, statin therapy demonstrated a protective effect on this group of patients, reducing their overall incidence of developing VTE," said study author Dr. Danai Khemasuwan.

Patients in the non-statin group were three times as likely to develop VTE as patients receiving statins, they found.

Given the good news/bad news conclusions of these two reports, patients should not panic, experts said. Statins provide significant benefits for patients with cardiovascular disease, Dr. Kalpalatha Guntupalli, president of the American College of Chest Physicians, said in a statement. However, as for any new medication prescribed, clinicians should closely monitor the effects that different types of statins have on individual patients.

More information

For more about heart failure, try the American Heart Association.

SOURCES: Gregg C. Fonarow, M.D., professor, medicine, the Eliot Corday Chair in Cardiovascular Medicine and Science, University of California at Los Angeles; Nov. 3, 2009, news release, American College of Chest Physicians

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