Fukuta Hidekatsu, Sane David C, Brucks Steffen, Little William C
Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045, USA.
Circulation. 2005 Jul 19;112(3):357-63. doi: 10.1161/CIRCULATIONAHA.104.519876. Epub 2005 Jul 11.
No therapy has been shown to improve survival in heart failure (HF) with a normal ejection fraction (EF). There are plausible reasons to hypothesize that statins may be of benefit in HF with a normal EF.
We evaluated 137 patients with HF and an EF > or =0.50. The effect of treatment received at study entry on survival was determined. During a follow-up of 21+/-12 months, 20 deaths were observed. Treatment with an ACE inhibitor or receptor blocker, beta-blocker, or calcium blocker had no significant effect on survival. In contrast, treatment with a statin was associated with a substantial improvement in survival (relative risk of death [95% CI] 0.22 [0.07 to 0.64]; P=0.006). Patients receiving statins had higher baseline LDL cholesterol than those not receiving statins (153+/-45 versus 98+/-33 mg/dL, P<0.01). After statin therapy, LDL cholesterol levels fell to a similar level (101+/-32 mg/dL) as in patients not receiving statins (98+/-33 mg/dL). After adjustment for differences in baseline clinical variables between groups (hypertension, diabetes, coronary artery disease, and serum creatinine), statin therapy was associated with lower mortality (adjusted relative risk of death [95% CI] 0.20 [0.06 to 0.62]; P=0.005). Similarly, after propensity matching, statin therapy was associated with improved survival (log-rank 6.12; P=0.013) and a trend toward improved survival without cardiovascular hospitalization (log-rank 3.02; P=0.082).
Statin therapy may be associated with improved survival in patients with HF and a normal EF.
尚无治疗方法被证明可改善射血分数（EF）正常的心力衰竭（HF）患者的生存率。有合理理由推测他汀类药物可能对EF正常的HF患者有益。
我们评估了137例HF患者，其EF≥0.50。确定了研究入组时接受的治疗对生存率的影响。在21±12个月的随访期间，观察到2例死亡病例。使用血管紧张素转换酶抑制剂或受体阻滞剂、β受体阻滞剂或钙通道阻滞剂治疗对生存率无显著影响。相比之下，使用他汀类药物治疗与生存率的显著改善相关（死亡相对风险[95%CI]0.22[0.07至0.64]；P = 0.006）。接受他汀类药物治疗的患者基线低密度脂蛋白胆固醇水平高于未接受他汀类药物治疗的患者（153±45对98±33mg/dL，P<0.01）。他汀类药物治疗后，低密度脂蛋白胆固醇水平降至与未接受他汀类药物治疗的患者相似的水平（101±32mg/dL）。在对组间基线临床变量（高血压、糖尿病、冠状动脉疾病和血清肌酐）的差异进行调整后，他汀类药物治疗与较低的死亡率相关（调整后的死亡相对风险[95%CI]0.20[0.06至0.62]；P = 0.005）。同样，在倾向匹配后，他汀类药物治疗与生存率改善相关（对数秩检验6.12；P = 0.013），且无心血管住院情况下生存率有改善趋势（对数秩检验3.02；P = 0.082）。
他汀类药物治疗可能与EF正常的HF患者生存率改善相关。
