BACKGROUND Statins are effective in the prevention of coronary events and the treatment of acute coronary syndromes. However, their efficacy and safety in patients with heart failure (HF) are unknown. In this review, we discuss the evidence for the efficacy and safety of statin therapy in patients with HF. METHODS We reviewed all original English-language, peer-reviewed journal articles published from 1985 to 2005 obtained from a search of the MEDLINE database. We focused on evidence for the efficacy and safety of statins based on data from patients with HF enrolled in major statin trials, analysis of the impact of statin use in patients with HF, and randomized clinical trials examining the effects of statins on cardiovascular outcomes in patients with HF. RESULTS The major primary and secondary prevention statin trials largely excluded patients with HF. Statin use was also limited in randomized HF trials. Subgroup and retrospective analyses, and evidence from prospective cohort studies of statin use in patients with HF suggest statins improve cardiovascular prognosis in HF. The limited small randomized clinical trials also suggest statins improve symptoms, ejection fraction, and inflammatory biomarkers in patients with HF. CONCLUSIONS A growing weight of evidence suggests that statins have beneficial effects in HF. At this time, there is little evidence to support withdrawing or withholding statins from patients with HF. Ongoing randomized controlled trials that examine the efficacy of statin therapy in patients with HF should clarify the role of these agents in the context of HF.