Management of dyslipidaemia in patients with comorbidities—facing the challenge: heart failure

The combined prevalence of heart failure (HF) with coronary atherosclerosis is frequent and often causally linked. The aim of this review is to elucidate whether lipid-lowering drugs (LLDs) are useful in this context. The role of LLDs is interesting in two ways: incidence of HF patients treated with LLD vs. outcomes in patients with a history of HF. Rosuvastatin and alirocumab have been tested in outcome trials specifically on patients with HF, the results are neutral since no benefit arose. To the contrary, use of statins in individuals without HF at baseline has been demonstrated to weakly but significantly reduce the incidence of HF. Overall, there is no notion that statins or other LLD are harmful in patients with HF. We will discuss the contribution of systemic inflammation and consider ischaemic vs. non-ischaemic HF. We conclude that in contrast to other comorbidities like, e.g. Type 2 diabetes mellitus (T2DM), in HF, we face a below-than-average efficacy of LLDs in terms of reducing hard cardiovascular endpoints.