Horwich Tamara B, MacLellan W Robb, Fonarow Gregg C
Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California 90095-1679, USA.
J Am Coll Cardiol. 2004 Feb 18;43(4):642-8. doi: 10.1016/j.jacc.2003.07.049.
This study aimed to investigate the impact of hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) therapy in patients with advanced heart failure (HF).
Although statins are known to reduce mortality in coronary artery disease (CAD), the impact of statin therapy in patients with HF has not been well studied. Both the potential risks and benefits of statins in HF have been described.
We studied a cohort of 551 patients with systolic HF (left ventricular ejection fraction [EF] <or=40%) referred to a single university center for clinical management and/or transplant evaluation. Survival without the necessity of urgent heart transplantation was determined.
The patients' mean age was 52 +/- 13 years; mean EF was 25 +/- 7%. Forty-five percent of the cohort had CAD, and 45% were receiving statin therapy, including 73% and 22% of CAD and non-CAD patients with HF, respectively. Patients receiving statins were significantly older and more likely to be male, with higher rates of hypertension, diabetes, and smoking. The EF and cholesterol levels were similar between treated and non-treated patients. Statin use was associated with improved survival without the necessity of urgent transplantation in both non-ischemic and ischemic HF patients (91% vs. 72%, p < 0.001 and 81% vs. 63%, p < 0.001 at one-year follow-up, respectively). After risk adjustment for age, gender, CAD, cholesterol, diabetes, medications, hemoglobin, creatinine, and New York Heart Association functional class, statin therapy remained an independent predictor of improved survival (hazard ratio 0.41 95% confidence interval 0.18 to 0.94).
Statin therapy is associated with improved survival in patients with ischemic and non-ischemic HF. Randomized trials are needed for confirmation of a therapeutic benefit.
本研究旨在调查羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）治疗对晚期心力衰竭（HF）患者的影响。
尽管已知他汀类药物可降低冠状动脉疾病（CAD）的死亡率，但他汀类药物治疗对HF患者的影响尚未得到充分研究。他汀类药物在HF中的潜在风险和益处均已被描述。
我们研究了一组551例收缩性HF患者（左心室射血分数[EF]≤40%），这些患者被转诊至单一大学中心进行临床管理和/或移植评估。确定无需紧急心脏移植的生存率。
患者的平均年龄为52±13岁；平均EF为25±7%。该队列中45%的患者患有CAD，45%的患者接受他汀类药物治疗，其中CAD和非CAD的HF患者分别占73%和22%。接受他汀类药物治疗的患者年龄显著更大，更可能为男性，高血压、糖尿病和吸烟率更高。治疗组和未治疗组患者的EF和胆固醇水平相似。在非缺血性和缺血性HF患者中，使用他汀类药物均与无需紧急移植的生存率提高相关（一年随访时分别为91%对72%，p<0.001和81%对63%，p<0.001）。在对年龄、性别、CAD、胆固醇、糖尿病、药物、血红蛋白、肌酐和纽约心脏协会功能分级进行风险调整后，他汀类药物治疗仍然是生存率提高的独立预测因素（风险比0.41，95%置信区间0.18至0.94）。
他汀类药物治疗与缺血性和非缺血性HF患者的生存率提高相关。需要进行随机试验以证实其治疗益处。
