SynthesisLipids in health and disease2019

Association of statin use and clinical outcomes in heart failure patients: a systematic review and meta-analysis.

Agata Bielecka-Dabrowa, Ibadete Bytyçi, Stephan Von Haehling, Stefan Anker, Jacek Jozwiak, Jacek Rysz, Adrian V Hernandez, Gani Bajraktari, Dimitri P Mikhailidis, Maciej Banach

Erratum issuedOpen access · goldFull text readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Lipids in health and disease, 2019. The graph read 3 numbers from its abstract, feeding 2 cells of the map, but none could be read as for or against, so it casts no vote. An erratum has been issued. Cited by 32 papers, 1 of them a synthesis that pooled it.

3numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 1 pooled it
3.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

Adverse events & safetycomparator not stated · heart_failurefeeds one cell of the map
HR 0.800.64 to 0.99p = 0.04
Similar reduced were observed for CV hospitalizations - they were reduced in statin users in both EF groups (HR 0.80 95CI: 0.64-0.99, p = 0.04, and HR 0.76 95% CI: 0.61-0.93, p  = 0.009, respectively, Fig. 6 ).
All-cause mortalitycomparator not stated · heart_failurefeeds one cell of the map
HR 0.770.72 to 0.83P < 0.0001
Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72-0.83, P < 0.0001, I CONCLUSIONS: In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level.
All-cause mortalitycomparator not stated · heart_failurefeeds one cell of the map
HR 0.770.72 to 0.83P  < 0.0001
Compared with non-statin users, statin users showed a lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72-0.83, P  < 0.0001, I 2 = 63%, Fig. 2 ), CV mortality (HR 0.82, 95% Cl: 0.76-0.88, P  < 0.000, I 2 = 63%) and CV hospitalization (HR 0.78, 95% Cl: 0.69-0.89, P  = 0.0003, I 2 = 36%, Fig. 3 a and b).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×adverse events & safety

No readable resultOpen on the map →What to test next →

11 readable studies in this cell: 3 favour the treatment, 7 find no difference, 1 favour the comparator.

Belief with this paper
0.16contested · 1 family supports, 4 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the comparatorfavours the treatment →
0 · no effect
NCT002899002,340 enrolled · 2006
Δ 13.79.40 to 18.0
NCT01294683977 enrolled · 2011
Δ -1.03-7.30 to 5.25
NCT00728988499 enrolled · 2008
Δ 1.00-7.30 to 9.30
NCT01678820299 enrolled · 2012
Δ -0.40-10.2 to 9.30

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×all-cause mortality

No readable resultOpen on the map →What to test next →

14 readable studies in this cell: 3 favour the treatment, 9 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

32 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Cardiometabolic Dysregulation and Heart Failure.Reviews in cardiovascular medicine · 2025
    Review
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Review
  14. Article
  15. Lipotoxicity as a therapeutic target in obesity and diabetic cardiomyopathy.Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques · 2024
    Review
  16. Article
  17. Article
  18. Lower low density lipoprotein cholesterol associates to higher mortality in non-diabetic heart failure patients.International journal of cardiology. Cardiovascular risk and prevention · 2023
    Article
  19. Review
  20. Article
6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

10 authors at 7 institutions in 7 countries.

Agata Bielecka-DabrowaDepartment of Hypertension, Medical University of Lodz, Rzgowska, 281/289; 93-338, Łódź, Poland.ORCID 0000-0001-6666-3999
Ibadete BytyçiClinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo.
Stephan Von HaehlingDepartment of Cardiology and Pneumology, University Medical Center Gottingen (UMG), Gottingen, Germany.
Stefan AnkerCharité-Universitätsmedizin Berlin, Berlin, Germany.
Jacek JozwiakDepartment of Family Medicine and Public Health, Institute of Medicine, University of Opole, Opole, Poland.
Jacek RyszDepartment of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland.
Adrian V HernandezHealth Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA.
Gani BajraktariClinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo.
Dimitri P MikhailidisDepartment of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK.
Maciej BanachDepartment of Hypertension, Medical University of Lodz, Rzgowska, 281/289; 93-338, Łódź, Poland. maciej.banach@icloud.com.
Medical University of Lodz · PLUniversity Clinical Center of Kosovo · XKCharité - Universitätsmedizin Berlin · DEPeruvian University of Applied Sciences · PEThe Royal Free Hospital · GBUniversitätsmedizin Göttingen · DEUniversity of Opole · PL

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundThe role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins' prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF.

methodsWe searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization.

resultsFinally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72-0.83, P < 0.0001, I

conclusionsIn conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.

Indexed as

Heart FailureHumansHydroxymethylglutaryl-CoA Reductase InhibitorsProspective StudiesTreatment OutcomeHydroxymethylglutaryl-CoA Reductase InhibitorsHeart failureHospitalizationMeta-analysisMortalityStatins

Identifiers

PMID31672151
PMCPMC6822388
OpenAlexW2989190856

What Socratic holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.