Statins have been shown to lower total and LDL cholesterol as well as to reduce coronary heart disease (CHD) mortality and morbidity, both in secondary and primary prevention. Recent data suggest that statin treatment may be beneficial for patients with heart failure (HF) as well. Retrospective and post-hoc analyses but also evidence from few prospective cohort studies performed so far support this. Beneficial effects of statins in HF could be explained by their improving left ventricular (LV) and autonomic function, modulating adverse cardiac remodeling and LV hypertrophy, influencing cellular effects of angiotensin II and down-regulating the angiotensin II type 1 receptors, reducing the risk of developing atrial fibrillation and ventricular arrhytmias, inhibition of metalloproteinases but also their antiinflammatory, antithrombotic and antifibrotic effects. The concerns that lowering serum cholesterol by statins may worsen the prognosis of HF patients because of their reduction of antioxidant ubiquinone (coenzyme Q 10) levels and increasing endotoxin (lipopolysaccharide) levels could not be confirmed so far. However, large-scale clinical trials are needed to provide definitive evidence of the value of statin treatment for patients with HF.