Statins and Exercise Training Response in Heart Failure Patients: Insights From HF-ACTION
Kelly JP, Dunning A, Schulte PJ, Fiuzat M, Leifer ES, Fleg JL, Cooper LS, Keteyian SJ, Kitzman DW, Pina IL, Kraus WE, Whellan DJ, O'Connor CM, Mentz RJ. Statins and exercise training response in heart failure patients: Insights from hf-action. JACC Heart Fail. Aug 2016;4(8):617-624.
JACC Heart Fail
OBJECTIVES: The aim of this study was to assess for a treatment interaction between statin use and exercise training (ET) response.
BACKGROUND: Recent data suggest that statins may attenuate ET response, but limited data exist in patients with heart failure (HF).
METHODS: HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) was a randomized trial of 2,331 patients with chronic HF with ejection fraction ≤35% who were randomized to usual care with or without ET. We evaluated whether there was a treatment interaction between statins and ET response for the change in quality of life and aerobic capacity (peak oxygen consumption and 6-min walk distance) from baseline to 3 months. We also assessed for a treatment interaction among atorvastatin, simvastatin, and pravastatin and change in these endpoints with ET. Multiple linear regression analyses were performed for each endpoint, adjusting for baseline covariates.
RESULTS: Of 2,331 patients in the HF-ACTION trial, 1,353 (58%) were prescribed statins at baseline. Patients treated with statins were more likely to be older men with ischemic HF etiology but had similar use of renin angiotensin system blockers and beta-blockers. There was no evidence of a treatment interaction between statin use and ET on changes in quality of life or exercise capacity, nor was there evidence of differential association between statin type and ET response for these endpoints (all p values >0.05).
CONCLUSIONS: In a large chronic HF cohort, there was no evidence of a treatment interaction between statin use and short-term change in aerobic capacity and quality of life with ET. These findings contrast with recent reports of an attenuation in ET response with statins in a different population, highlighting the need for future prospective studies. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437).
Medical Subject Headings
Aged; Atorvastatin; Exercise Therapy; Exercise Tolerance; Female; Heart Failure; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Linear Models; Male; Middle Aged; Oxygen Consumption; Pravastatin; Quality of Life; Simvastatin; Stroke Volume; Treatment Outcome; Walk Test