1994 was the year that statin was known by most physicians worldwide with the publication of the Scandinavian Simvastatin Survival Study (4S) trial.  In that， survival benefits were clearly demonstrated in patients with coronary heart disease over 6 years observation period. Since then， numerous clinical trial including HPS trial all evidenced the convincing effect of various statins on  reducing vascular and all-cause mortality in high risk patients (coronary disease， other occlusive arterial disease， diabetes， hypertension). Started as a lipid lowering medications， more and more pleiotropic effects of statins were demonstrated in the following years and sometimes they were marketed as “all round players” in the cardiovascular medicine. However， there is still no solid data supporting the routine use of statins in patients with moderate and severe heart failure. The GISSI-HF trial found no clinical benefit from statin therapy in patients with chronic heart failure (HF)， in the GISSI-HF trial， 4574 eligible patients (40% of patients had ischemic HF) were randomized to rosuvastatin 10 mg daily or placebo. Patients had HF of any cause， in New York Heart Association functional class II-IV， and with any left ventricular ejection fraction level. 29% of rosuvastatin-treated patients versus 28% of placebo-treated patients died from any cause (hazard ratio [HR]=1.00， p>0.05)， while a corresponding 57% versus 56% of patients died or were admitted to hospital for cardiovascular reasons (HR=1.01， p>0.05). GISSI-HF results thus extend those of CORONA (Controlled Rosuvastatin Multinational Trial in HF)， CORONA included only aged patients (>60 years) with coronary heart disease and LVEF<0.4 (n=5011)， and showed that cholesterol-lowering effects of statins do not reduce ischemic events in HF patients and that the apparent pleiotropic effects of statins do not influence HF development. The possible reasons for the neutral effects are discussed by the negative impact of cholesterol lowering effect of statins in HF patients based on observations of association between low serum total cholesterol and higher mortality in advanced heart failure patients. Some investigators postulated that reduced cholesterol level in CHF　patients might reduce the binding capacity of lipoprotein to lipopolysaccharide， thus increased the detrimental effect of the latter. Moreover， reduced coenzyme Q10 level by statins might be another reason offsetting the beneficial effect of statins in CHF patients. Future studies are warranted to clarify the role of statins in patients in the early stages of HF.

Take home message:
1. Statins should be given to patients in high cardiovascular risk and patients with coronary heart disease without HF to reduce the onset of HF and overall mortality.
2. For patient with heart failure， we could not expect to achieve more survival benefit by adding statins to the modern HF therapy regimen.