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

• Published in: The Korean journal of internal medicine 2014, 29(6), , pp.754-763
• Main Authors: Lee, Hae-Young, Cho, Hyun-Jai, Kim, Hee-Yul, Jeon, Hee-Kyung, Shin, Joon Han, Kang, Suk-Min, Baek, Sang Hong
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers - blood; Cholesterol, LDL - blood; Down-Regulation; Dyslipidemias - blood; Dyslipidemias - diagnosis; Dyslipidemias - drug therapy; Dyslipidemias - epidemiology; Exercise Tolerance - drug effects; Female; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart Failure - physiopathology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Male; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - drug therapy; Myocardial Ischemia - epidemiology; Myocardial Ischemia - physiopathology; Original; Pravastatin - administration & dosage; Pravastatin - adverse effects; Prospective Studies; Quinolines - administration & dosage; Quinolines - 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; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2014.29.6.754

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. 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. 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). 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.