Statins and dilated cardiomyopathy: do we have enough data?

INTRODUCTION: Dilated cardiomyopathy (DCM) is a multifactorial disease in which there is enlargement and systolic dysfunction of one or both ventricles. The exhaustion of compensatory mechanisms leads to the symptoms of congestive heart failure (CHF). Despite treatment, CHF is a progressive disease with high morbidity and mortality, suggesting that important pathogenic mechanisms remain active and unmodified by currently available treatment. AREAS COVERED: Several lines of evidence suggest that inflammation plays a role in the development and progression of CHF, influencing heart contractility and hypertrophy, promoting apoptosis and contributing to myocardial remodeling. More general immunomodulating treatments, such as statins, have shown promising results in patients with cardiomyopathies. MEDLINE (1966 - May 2010), EMBASE and SCOPUS (1965 - May 2010) and DARE (1966 - May 2010) were searched, in addition to abstracts from national and international cardiovascular meetings. The main data search terms were: dilated cardiomyopathy, dyslipidemia, heart failure, left ventricle dysfunction and statins. EXPERT OPINION: Inhibition of inflammation, alleviating endothelial damage and reducing endothelial dysfunction might comprise part of the underlying mechanisms leading to the improvement of left ventricular function and exercise tolerance in patients with DCM. Candidates for statin therapy with DCM should be in New York Heart Association class II or III and should have normal or increased levels of lipids.