Lipid-lowering therapy is associated with lower mortality in heart failure patients: Insights from Swedish national registries data from 2006 to 2022

Abstract Background Previous studies have not shown prognostic benefits of statins in heart failure patients. However, they used higher LDL cholesterol targets than current guidelines. Given evolving lipid management strategies over the last decades, it is essential to reassess the survival benefits of lipid-lowering therapy in heart failure (HF) patients based on modern LDL targets. Aim To evaluate one-year mortality and mortality risk in heart failure (HF) patients receiving lipid-lowering therapy versus those not treated between 2006 and 2022. Methods Patients with incident HF were identified in the Swedish Heart Failure Register (SwedHF) and linked to the National Patient Register (NPR), Cause of Death Register, and Prescribed Drug Register. They were categorized by lipid-lowering therapy use and followed for one year. The study periods were 2006–2011, 2012–2018, and 2019–2022. Cox proportional hazards models, adjusted for clinical covariates, analyzed one-year mortality risk. Subgroup analyses considered ejection fraction (EF) and ischemic heart disease (IHD) status. Results A total of 33,687 heart failure patients were included across three periods. Among them, 17,882 (53.1%) received lipid-lowering treatment, while 15,805 (46.9%) did not. Treated patients were older (72.1 ± 10.7 vs. 71.5 ± 14.5 years, p 0.0001). More men than women received treatment (67.2% vs. 32.8%, p 0.0001). The lipid-lowering group had higher rates of IHD (64.8% vs. 18.8%), diabetes (32.2% vs. 13.1%), hypertension (69.0% vs. 54.3%), and chronic kidney disease (6.1% vs. 4.0%) (all p 0.0001). One-year all-cause mortality was higher in untreated patients (10.1% vs. 7.5%, p 0.0001) and remained significant in each period: 2006–2011 (11.5% vs. 7.7%), 2012–2018 (9.6% vs. 7.8%), and 2019–2022 (7.0% vs. 5.1%) when compared to patients not on lipid-lowering treatment (all p 0.05). Mortality risk declined over time in treated patients: HR 0.63 (95% CI 0.56–0.71) in 2006–2011, HR 0.72 (95% CI 0.64–0.82) in 2012–2018, and HR 0.56 (95% CI 0.41–0.76) in 2019–2022. Patients with IHD appeared to benefit more, Figure 1. Conclusion This study demonstrates a decline in mortality risk from 2006 to 2022 among heart failure patients receiving lipid-lowering treatment compared to those not treated. The beneficial effect was particularly notable in patients with IHD, although the trend did not reach statistical significance. These findings suggest that lipid-lowering treatment may contribute to improved survival outcomes in heart failure patients, but further research is needed to confirm the observed trends.