In addition to their lipid lowering effects, statins have been reported to be effective in treating heart failure. All the randomized trials evaluating statins for heart failure were combined in a recent meta-analysis. The statins used included atorvastatin in 6 moderate quality trials, rosuvastatin in 3 trials (1 of high quality), and simvastatin in 1 small trial. The meta-analysis combining all trials was limited by significant heterogeneity, but analyses were also done for each statin alone. Atorvastatin was found to significantly decrease both all-cause mortality (odds ratio 0.39, p = 0.004) and hospitalization for worsening heart failure (odds ratio 0.3, p < 0.00001) (level 2 [mid-level] evidence). In contrast, rosuvastatin had no effect on either overall mortality or hospitalization for heart failure (level 1 [likely reliable] evidence). Furthermore, atorvastatin was associated with an increase in left ventricular ejection fraction (weighted mean difference 5.49%, p < 0.0001) in analysis of 4 trials, but rosuvastatin was associated with a lower ejection fraction (mean difference -3.07%, p = 0.002) in the 1 trial with data for that outcome (level 3 [lacking direct] evidence). The one trial evaluating simvastatin had only 51 patients. It found no significant differences in clinical outcomes, but there was a small improvement in the simvastatin group for ejection fraction (mean difference 6%, p < 0.00001) (Am J Cardiol 2009 Dec 15;104(12):1708).