John Kjekshus talks with
ScienceWatch.com and answers a few questions about
this month's New Hot Paper in the field of Clinical
Medicine.
Article Title: Rosuvastatin in older patients with
systolic heart failure
Authors: Kjekshus,
J, et al.
Journal: N ENGL J MED
Volume: 357
Issue: 22
Page: 2248-2261
Year: NOV 29 2007
* Univ Oslo, Rikshosp, Dept Cardiol, N-0027 Oslo,
Norway.
* Univ Oslo, Rikshosp, Dept Cardiol, N-0027 Oslo,
Norway.
* Inst Cardiol, Bucharest, Romania.
* Univ Saarlandes Klinikum, Homburg, Germany.
(addresses have been truncated)
Why do you think your paper is highly
cited?
This paper was the first to examine in a prospective manner the effects of
a statin (rosuvastatin 10 mg) compared to placebo in chronic heart failure
of ischemic etiology. The results were neutral with respect to
cardiovascular mortality, non-fatal myocardial infarction and stroke. This
was unexpected because a large number of previous studies in non-heart
failure patients had demonstrated convincing effects on coronary outcomes.
This raises important questions about mechanisms of action and about
differences between heart failure and non-heart failure patients.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
"...we had difficulties in finding
resources and recruiting investigators to the
study."
The discovery is new and unexpected. Previous observational findings in
heart failure trails had suggested that statins are highly effective among
users compared to non-users. In contrast to these studies the CORONA study
was prospective, randomized, and double-blinded. Observational studies are
subject to selection bias in treatment allocation which markedly limits the
clinical relevance of their observations.
Would you summarize the significance of your paper
in layman's terms?
Although rosuvastatin was well tolerated in heart failure patients, we did
not meet the expected reduction in the number of heart attack events as
obtained in patients without heart failure. However, we demonstrated a
significant reduction in the number of patients hospitalized for heart
failure. Further analysis of the CORONA study results will provide an
understanding of the role of statins in heart failure patients.
How did you become involved in this research, and
were there any problems along the way?
I had been involved with statin trials in patients with coronary heart
disease but heart failure was reason for exclusion and we simply did not
know if statins would work in heart failure. Many wanted to extrapolate
findings from the studies of patients without to patients with heart
failure. Consequently we had difficulties in finding resources and
recruiting investigators to the study.
Where do you see your research leading in the
future?
In the future I will be targeting mechanisms which might explain the lack
of statin effect in heart failure in order to improve on heart failure
treatment in general.
Do you foresee any social or political implications
for your research?
The observation that statin treatment in heart failure patients at best has
a modest effect may cause adjustment of treatment guidelines and
reimbursement strategies.
John Kjekshus
Professor emeritus, Dr. Med.
Department of Cardiology
Rikshospitalet University Hospital and Faculty of Medicine
University of Oslo
Oslo, Norway
Keywords: rosuvastatin, statin, chronic heart failure, ischemic
etiology, cardiovascular mortality, non-fatal myocardial infarction,
stroke, differences between heart failure and non-heart failure
patients, the corona study, statin trials in patients with coronary
heart disease.