The Impact of Statin Therapy on Neurological Events Following Left Ventricular Assist System Implantation in Advanced Heart Failure

Abstract Background Stroke is a leading cause of disability and death in advanced heart failure patients supported with continuous-flow left ventricular assist systems (CF-LVAS). Statins (HMG-CoA Reductase Inhibitors) reduce the risk of major cardiovascular and neurological events, such as stroke, but their impact has not been evaluated in patients implanted with CF-LVAS. We sought to explore the association between use of statin therapy and subsequent occurrence of neurological events, particularly stroke, following CF-LVAS implantation. Methods We performed a single centre, retrospective, observational cohort study in 200 consecutive adults implanted with a durable CF-LVAS over a 10-year period (2008-2018). We compared patients according to statin use following pump implantation, stratified by an exploratory analysis of pump type (HeartMate II, HeartWare HVAD and HeartMate 3 LVAS). Results Overall, 24% of CF-LVAS recipients developed at least one neurological event, at a rate of 0.11 events per patient-year (EPPY) among those prescribed statins and 0.22 EPPY among non-users (age-adjusted HR 0.46; 95% CI,0.24–0.88; P=0.019). In the cohort without the HeartMate 3 (HM3) pump, ischemic strokes were 62% lower among statin users (0.05 versus 0.12 EPPY for non-users; age-adjusted HR, 0.38; 95% CI, 0.15–0.99; P=0.048). The risk of ischemic stroke did not differ significantly when HM3 recipients were included in the analysis (age-adjusted HR, 0.51; 95% CI, 0.22–1.21; P=0.13). However, ischemic stroke rate in HM3 LVAS recipients was similar to the rate in statin users who received a non-HM3 LVAS (0.06 and 0.05 EPPY respectively). Rates of haemorrhagic stroke and other safety endpoints were not significantly different according to statin use. Conclusion Statin prescription following CF-LVAS is associated with lower rates of neurological events, driven predominantly by a reduction in ischemic strokes. These findings suggest that most patients with a pre-existing indication for statin therapy may continue using statins following CF-LVAS in an effort to decrease the incidence of ischemic stroke.