Meta-analysis of the effect of statins on mortality in patients with preserved ejection fraction.

No therapy has been shown to improve survival rate in heart failure with preserved ejection fraction (HFPEF). Recent observational studies of the association between statin use and the risk of mortality in HFPEF have shown mixed results. The goal of the present study was to systematically review all published observational studies evaluating the effect of statins on the risk of mortality in HFPEF. A literature search in the PubMed and EMBASE databases was undertaken through December of 2013. Combined relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random-effects model. Subgroup analyses, sensitivity analysis, and cumulative meta-analysis were also performed. A total of 11 eligible studies with 17,985 patients with HFPEF were included in the analysis. Statin use was associated with a 40% lower risk of mortality (RR 0.60, 95% CI 0.49 to 0.74, p<0.001). Stratification of studies by controlled or uncontrolled confounding factors affected the final estimate (confounder-controlled RR 0.63, 95% CI 0.51 to 0.77, p<0.001 and confounder-uncontrolled RR 0.49, 95% CI 0.24 to 1.01, p=0.053). Furthermore, sensitivity analysis confirmed the stability of the results. Cumulative meta-analysis showed an obvious trend of reduction in mortality rates in statin users from 2005 to 2013. In conclusion, our meta-analysis supports the hypothesis that statin therapy may be associated with improved survival rates in patients with HFPEF. Nevertheless, randomized controlled trials are needed to confirm the efficacy of statins in HFPEF.