The 2013 ACC/AHA guideline for the treatment of blood cholesterol makes no recommendations for the initiation or discontinuation of statins in patients with NYHA class II to IV ischemic HFrEF.5 Treatment With n-3 Polyunsaturated Fatty Acids in Patients With HF The use of a different type of lipid therapy, n-3 polyun- saturated fatty acids (PUFAs), has also been investigat- ed in the treatment of HF. Use of PUFA gained interest in HF on the premise that primary and secondary pre- vention trials in patients with coronary heart disease demonstrated a 10% to 20% relative risk reduction in fatal and nonfatal cardiovascular events with PUFA sup- Furthermore, in clinical and preclinical studies, PUFA use has been associated with antiar- rhythmic effects, with a beneficial impact on sudden Thus, in the GISSI-HF trial, 6975 patients with NYHA class II to IV chronic HF were ran- domized to therapy with 1 g PUFA daily or placebo.278 Of note, 50% of patients had ischemic cardiomyopa- thy and <10% had HFpEF. Treatment with PUFA was associated with a significant decrease in the primary end points of time to death and time to death or admis- sion to hospital for cardiovascular reasons.277 279 The number needed to treat was 56 patients with chronic HF for a median duration of 3.9 years to avoid 1 death Table 11. Recommendations for the Treatment of Hyperlipidemia in Stage C HF: Patients With Cardiac Structural Abnormalities or Remodeling With Prior or Current Symptoms of HF Recommendations COR LOE Referenced Guideline References PUFA supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations. 