Why do you think your paper is highly cited?

This paper was the first to examine in a prospective manner the effects of a statin (rosuvastatin 10 mg) compared to placebo in chronic heart failure of ischemic etiology. The results were neutral with respect to cardiovascular mortality, non-fatal myocardial infarction and stroke. This was unexpected because a large number of previous studies in non-heart failure patients had demonstrated convincing effects on coronary outcomes. This raises important questions about mechanisms of action and about differences between heart failure and non-heart failure patients.

 Does it describe a new discovery, methodology, or synthesis of knowledge?

The discovery is new and unexpected. Previous observational findings in heart failure trails had suggested that statins are highly effective among users compared to non-users. In contrast to these studies the CORONA study was prospective, randomized, and double-blinded. Observational studies are subject to selection bias in treatment allocation which markedly limits the clinical relevance of their observations.

 Would you summarize the significance of your paper in layman's terms?

Although rosuvastatin was well tolerated in heart failure patients, we did not meet the expected reduction in the number of heart attack events as obtained in patients without heart failure. However, we demonstrated a significant reduction in the number of patients hospitalized for heart failure. Further analysis of the CORONA study results will provide an understanding of the role of statins in heart failure patients.

 How did you become involved in this research, and were there any problems along the way?

I had been involved with statin trials in patients with coronary heart disease but heart failure was reason for exclusion and we simply did not know if statins would work in heart failure. Many wanted to extrapolate findings from the studies of patients without to patients with heart failure. Consequently we had difficulties in finding resources and recruiting investigators to the study.

 Where do you see your research leading in the future?

In the future I will be targeting mechanisms which might explain the lack of statin effect in heart failure in order to improve on heart failure treatment in general.

 Do you foresee any social or political implications for your research?

The observation that statin treatment in heart failure patients at best has a modest effect may cause adjustment of treatment guidelines and reimbursement strategies.

John Kjekshus
Professor emeritus, Dr. Med.
Department of Cardiology
Rikshospitalet University Hospital and Faculty of Medicine
University of Oslo
Oslo, Norway

Keywords: rosuvastatin, statin, chronic heart failure, ischemic etiology, cardiovascular mortality, non-fatal myocardial infarction, stroke, differences between heart failure and non-heart failure patients, the corona study, statin trials in patients with coronary heart disease.