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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nell\u0027Infarto miocardico \u2014 Insufficienza cardiaca) provides support for the use of fish oil supplements in patients with symptomatic heart failure but indicates no benefit of statin therapy in this patient population. Fish oil supplements reduced the risk of all-cause death or hospitalization for cardiovascular causes, while treatment with rosuvastatin had no effect on these outcomes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EGISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nell\u0027Infarto miocardico \u2013 Insufficienza cardiaca) provides support for the use of fish oil supplements in patients with symptomatic heart failure (HF) but indicates no benefit of statin therapy in this patient population. Fish oil supplements reduced the risk of all-cause death or hospitalization for cardiovascular (CV) causes, while treatment with rosuvastatin had no effect on these outcomes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe GISSI-HF program included 2 nested studies that were designed to evaluate n-3 polyunsaturated fatty acids (PUFA) and statins among patients who received optimal medical therapy for HF. Study investigators Luigi Tavazzi, MD, Policlinico San Matteo di Pavia, Pavia, Italy, presented the n-3 PUFA results, and Gianni Tognoni, MD, Consorzio Mario Negri Sud, Chieti, Italy, reported the rosuvastatin findings, which were simultaneously published online in \u003Cem\u003EThe Lancet\u003C\/em\u003E [GISSI-HF Investigators. \u003Cem\u003ELancet\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EGISSI-HF (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00336336\u0026amp;atom=%2Fspmdc%2F8%2F6%2F14.atom\u0022\u003ENCT00336336\u003C\/a\u003E) enrolled 6975 patients with chronic New York Heart Association (NYHA) class II-IV HF, regardless of etiology and with any baseline left ventricular ejection fraction. Patients were randomly assigned to treatment with n-3 PUFA 1 g daily or placebo, and those who had neither a clear indication nor a contraindication to statin therapy (n=4574) also were randomly assigned to treatment with rosuvastatin 10 mg daily or placebo. The 2 primary endpoints were all-cause mortality and all-cause mortality or hospitalization for CV events.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBenefits with Fish Oil Supplements\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAfter a median of 3.9 years, 27.3% of patients in the n-3 PUFA group and 29.1% of patients in the placebo group died from any cause (p=0.041). After adjusting for recent HF hospitalization, prior pacemaker implantation, and the presence of aortic stenosis, treatment with n-3 PUFA reduced the relative risk (RR) of death by 9% (HR=0.91; 95% CI, 0.83 to 0.99).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EFish oil supplementation also reduced the RR of death or hospital admission for CV events by 8%, from 59.0% in the placebo group to 56.7% in the n-3 PUFA group (p=0.009). In addition, according to subgroup analyses, patients who were treated with n-3 PUFA were less likely than placebo recipients to be hospitalized for ventricular arrhythmia (2.8% vs 3.8%; p=0.013).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ELow-dose n-3 PUFA was very well tolerated, with no excess in treatment discontinuations (28.7% vs 29.6% in the placebo group) or adverse events (2.9% vs 3.0%). A similar number of patients in the n-3 PUFA group (n=96) and the placebo group (n=92) reported gastrointestinal problems, the most common adverse event.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENeutral Effects of Statin Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ETreatment with rosuvastatin did not improve prognosis in the GISSI-HF trial. Patients in the rosuvastatin and placebo groups were equally likely to reach the endpoints of all-cause mortality (28.8% and 28.1%, respectively; p=0.660) and all-cause mortality or CV hospitalization (57.1% vs 56.1%; p=0.594). Moreover, there were no differences between the treatment groups in the endpoint components of CV mortality, sudden cardiac death, CV hospitalization, fatal and nonfatal myocardial infarction (MI), or fatal and nonfatal stroke.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ERosuvastatin failed to alter mortality despite clear pharmacologic activity, including beneficial effects on low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP), a marker of inflammation. Whereas LDL-C levels remained relatively steady in the placebo group (increasing by 7% at Year 1 and decreasing by 2% at Year 3), LDL-C levels dropped by 32% at Year 1 and remained reduced by 27% compared with baseline at Year 3 in the rosuvastatin group (p\u0026lt;0.001). After 3 months of therapy, the mean hsCRP level dropped by 4.6% in the placebo group and 16.6% among those who received rosuvastatin (p=0.020).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EGISSI-HF joins CORONA (Controlled Rosuvastatin Multinational Trial in HF) in showing that statin therapy does not lessen the risk of death in patients with HF [Kjekshus J et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007]. Compared with GISSI-HF, CORONA evaluated an older group of patients (mean age, 68 years vs 73 years) with a greater prevalence of ischemic HF (40% vs 100%) and more severe disease (37% vs 63% NYHA III\/IV). However, the findings of GISSI-HF mirror those of CORONA: rosuvastatin has a neutral effect in HF patients.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EClinical Implications\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe role of statins in HF, and the clinical implications of GISSI-HF in particular, will be a source of debate within the cardiology community, said Philip A. Poole-Wilson, MD, Imperial College, London, UK. Given the findings of CORONA and GISSI-HF, Prof. Poole-Wilson argued that patients with symptomatic HF (NYHA II-IV) should not be started on statin therapy and that those who already are taking statins should have these agents withdrawn. For patients who have structural or functional defects but no HF symptoms (NYHA I), the clinical consequences of GISSI-HF are less clear.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EProf. Tognoni had a more conservative interpretation of the GISSI-HF findings. Although statins should not be given to patients with HF that is of nonischemic etiology, physicians should carefully consider the benefits of continuing or discontinuing statin therapy in patients with ischemic HF, he said. For example, discontinuing statin therapy may improve compliance with other concurrent, evidence-based treatments.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EOverall, the neutral findings of GISSI-HF do not diminish the valuable role of statins in CV risk reduction. \u201cPatients with coronary heart disease without HF must be started and maintained on statin therapy,\u201d Prof. Poole-Wilson concluded.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/6\/14.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmcs3\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}