A 79-year-old obese woman with a history of hypertension and coronary stenting presented to the emergency department with acute-onset shortness of breath. Results of the physical examination showed a blood pressure of 220/110 mm Hg, pulse of 100 beats per minute, respiratory rate of 18 breaths per minute, and jugular venous pressure of 11 cm H2O. The patient was afebrile, and there was no pitting edema in the legs. There were bilateral rales in three quarters of the lungs.
Cardiac examination showed a regular rhythm and no murmur. Chest radiography showed bilateral pulmonary edema. Acute myocardial infarction was ruled out by serial enzyme tests. Echocardiography showed normal left ventricular ejection fraction, concentric left ventricular hypertrophy, and a mildly dilated left atrium.
The patient was diagnosed with diastolic heart failure. She quickly responded to an intravenous diuretic and nitroglycerin. The blood pressure returned to normal. Subsequent chest radiographs showed complete resolution of the pulmonary edema. Dobutamine stress echocardiography showed no evidence of inducible ischemia. The laboratory values were as follows: total cholesterol, 205 mg/dL; high-density lipoprotein cholesterol, 49 mg/dL; triglycerides, 106 mg/dL; low-density lipoprotein cholesterol, 135 mg/dL; serum creatinine, 1.8 mg/dL; and plasma B-type natriuretic peptide, 520 pg/mL. The patient’s medications on admission included aspirin, 325 mg; benazepril (Lotensin), 20 mg; metoprolol (Lopressor), 50 mg; and furosemide (Lasix), 40 mg. Should she be started on an HMG-CoA reductase inhibitor (statin)?
There is no randomized controlled trial examining whether statins improve survival in patients with diastolic heart failure. Nevertheless, given the patient’s significant history of coronary artery disease, her increased cholesterol levels, and the results presented in our article “Statin therapy in diastolic heart failure,” she should receive statin therapy.