Monday, November 13, 2006

CCF: An inflmatory disease?

There has been much speculation that there is a strong inflammatory component in heart failure, especially in systolic heart failure. This is another addition to the wide spectrum of cardiovascular disease, that have taken on an inflammatory aspect. Atherosclerosis has a strong inflammatory basis. T2DM, hypertension, atrial fibrillation and now systolic heart failure, may also have an inflammatory etiology. Interesting, isn't it. We are all aware of the mutiple inflammatory markers that are elevated in CCF, including BNP and hsCRP and other cytokines.

The November 1st issue of the Journal of the American Medical Association, carried an article by Dr S Go, on the improvement in prognosis in 24,000 patients of Kaiser Permanente of Northern California, who were admitted with heart failure and found that those who were also given statins, seemed to do better over 2.4 years of followup, with fewer deaths and fewer re-admissions. The patients on statins may have done better then those on valsartan in the velHf trial. This was a generalisation. They were not a head to head comparison, and the Dr S Go study was very much a registry, retrospective analysis, not a RCT. It however gives us an insight that statins may be helpful in CCF (there were previous studies which also showed this).

Obviously, we are keen to ask how? How does statins improve the prognosis of systolic heart failure. Dr S Go feels that it could be due to the anti-inflammatory effects of statins, including the improved endothelial function, and also reduction in inflammatory indices. I however did not see any inflammatory markers estimated, so the opinion may just be another generalisation.

We can take consolation in the fact that in our patients with coronary artery disease, given statins, we are also lowering their chance of heart failure. Another testament to the extra-cholesterol lowering effect of statins.

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