Clinical trial NCT00233480: Statin Therapy in Heart Failure: Potential Mechanisms of Benefit
Official title: A Double-blind Randomized, Placebo-Controlled, Single-Center Study to Assess the Impact of Statins on the Autonomic Nervous System and Cardiac Structure/Function in Non-Ischemic Heart Failure
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Heart Failure, Congestive
Keywords: Randomized Controlled Trial
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Sympathetic Nervous System
Ventricular Remodeling
Chemokines
Lead sponsor: University of California, Los Angeles
Sponsor class: OTHER
Collaborators: name: Pfizer
name: National Heart, Lung, and Blood Institute (NHLBI)
First posted: 2005-10-05
Enrollment: 27
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The goal of the investigators' study is to further understand the potentially beneficial effects of statin therapy in patients with heart failure. It is hypothesized that statins will 1) increase the heart's pumping ability 2) improve functioning of the sympathetic nervous system and 3) decrease immune activation in heart failure.

Detailed description: Recent evidence suggests that HMG-Coenzyme A (statin) therapy may be associated with improved survival in both ischemic and non-ischemic heart failure (HF). Large, randomized outcome studies of statins in HF are currently underway, but these trials will not address underlying mechanisms. The aim of the study is to investigate statins' potentially beneficial mechanisms of action in HF, focusing on: 1) sympathetic nervous system activation and 2) myocardial remodeling, and 3) immune activation in heart failure.

Fifty patients with systolic HF of non-ischemic etiology from a single center will be randomized in a double-blinded fashion to 3 months of atorvastatin 10mg QD (25 subjects) vs matching placebo QD (25 subjects). The following exams will be performed at baseline (pre-treatment) and at end of study (post-treatment): sympathetic microneurography, echocardiography, and peripheral blood chemokine analysis. Sympathetic microneurography at the peroneal nerve will directly quantify changes in sympathetic nerve activity (bursts/minute). Echocardiography (with the addition of MRI in a subset of subjects without pacemakers or implantable defibrillators) will be used to track changes in cardiac structure and function; indices of remodeling will include measurement of left ventricular mass index, left ventricular volume indices, left ventricular ejection fraction, and subendocardial scar quantification (MRI only). Immune activation will be characterized by circulating cytokines and chemokines. Additionally, quantification of established cardiac biomarkers (cardiac troponin, B-type natriuretic peptide, and C-reactive Protein), Holter monitor/heart rate variability studies, and quality of life and global clinical assessment will be performed pre- and post- treatment.

Neither sympathetic microneurography nor MRI have been previously utilized to assess statins' effects in humans with HF. The impact of statin therapy on inflammatory chemokine activation in HF also has not been studied. The knowledge gained from our proposed investigations may serve as a basis for understanding how statin therapy has potential to improve clinical outcomes in HF, and may ultimately lead to new therapeutic strategies for HF.

Eligibility criteria: Inclusion Criteria:

* Age≥18 years old
* LVEF ≤ 35%, as documented by echocardiography, radionuclide ventriculography, gated SPECT, or contrast ventriculography within past 6 months
* Symptomatic HF (NYHA II-IV) or current NYHA I with history of symptomatic HF within the last year
* Stable doses of optimal HF medical therapy, unless documented contraindication.

Exclusion Criteria:

* Ischemic etiology of HF, defined as the presence of at least one of the following four criteria; angiographic evidence of \> 50% lesion in 1 or more of the 3 major epicardial vessels; history of myocardial infarction; history of revascularization procedure; evidence of significant perfusion defect in the setting of ischemic symptoms.
* Clinical indication for statin treatment - coronary artery, cerebrovascular, or peripheral vascular disease
* Major cardiovascular event or surgical procedure within past 8 weeks
* LDL\<70 mg/dL
* HF secondary to congenital heart disease or uncorrected valvular disease
* Treatment with statin within past 2 months
* Pregnancy
* Contraindication to statin: moderate liver disease, AST/ALT \> 150 U/ L, known hypersensitivity
* Likely to receive heart transplant within 3 months
* Known peripheral or autonomic neuropathy

Primary outcomes:
measure: LVEF (Left Ventricular Ejection Fraction)
timeFrame: baseline and three months
measure: Muscle Sympathetic Nerve Activity (by Sympathetic Microneurography)
timeFrame: Baseline and three months
Secondary outcomes:
measure: Left Ventricular End-diastolic Dimension (LVEDD)
timeFrame: Baseline and three months
measure: Cardiac Biomarker Level BNP
timeFrame: Baseline, 3 months
measure: High-sensitivity C-reactive Protein (hsCRP) as a Cardiac Biomarker
timeFrame: Baseline, Three months
measure: Cardiac Troponin I (cTnI)
timeFrame: Baseline, Three months
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Ahmanson-UCLA Cardiomyopathy Center
state: California
Study officials:
affiliation: UCLA Division of Cardiology
name: Tamara B Horwich, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Horwich TB, Middlekauff HR. Potential autonomic nervous system effects of statins in heart failure. Heart Fail Clin. 2008 Apr;4(2):163-70. doi: 10.1016/j.hfc.2008.01.004.
citation: Horwich TB, MacLellan WR. Atorvastatin and statins in the treatment of heart failure. Expert Opin Pharmacother. 2007 Dec;8(17):3061-8. doi: 10.1517/14656566.8.17.3061.
citation: PubMed ID 22041323
citation: Horwich TB, Middlekauff HR, Maclellan WR, Fonarow GC. Statins do not significantly affect muscle sympathetic nerve activity in humans with nonischemic heart failure: a double-blind placebo-controlled trial. J Card Fail. 2011 Nov;17(11):879-86. doi: 10.1016/j.cardfail.2011.07.008. Epub 2011 Sep 3.