Mozaffarian Dariush, Minami Elina, Letterer Rebecca A, Lawler Richard L, McDonald George B, Levy Wayne C
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Am J Cardiol. 2005 Dec 15;96(12):1699-704. doi: 10.1016/j.amjcard.2005.07.092. Epub 2005 Oct 28.
In observational studies, statins are associated with lower mortality in patients with heart failure (HF), including those with nonischemic HF. Such benefits could be related to anti-inflammatory effects; however, the effects of statins on systemic inflammation in HF are not well-established. We conducted a 16-week, single-center, randomized, double-blind, placebo-controlled, crossover clinical trial of the effects of atorvastatin 10 mg/day on concentrations of systemic inflammatory markers in 22 patients with HF (including 20 with nonischemic HF) with New York Heart Association class II or III symptoms and left ventricular ejection fraction of <40%. The absolute and percentage of changes in inflammatory marker levels were evaluated using analysis of variance. Statin treatment reduced the concentrations of soluble tumor necrosis factor receptor-1 by 132 pg/ml (p = 0.04) and 8% (p = 0.056), C-reactive protein by 1.6 mg/L (p = 0.006) and 37% (p = 0.0002), and, after adjustment for treatment order, endothelin-1 by 0.21 pg/ml (p = 0.007) and 17% (p = 0.01). In post hoc analyses, the reduction in tumor necrosis factor receptor-1 levels was highest among patients with elevated levels at baseline (at or higher than the median of 1,055 pg/ml, p interaction = 0.001), among whom statin therapy reduced the levels by 306 pg/ml (p <0.001) and 22% (p <0.001). Statin treatment did not significantly affect the levels of other inflammatory markers, including interleukin-6 and brain natriuretic peptide. In conclusion, short-term atorvastatin therapy reduced the levels of several important inflammatory markers in patients with HF.
在观察性研究中，他汀类药物与心力衰竭（HF）患者（包括非缺血性HF患者）的死亡率降低相关。这种益处可能与抗炎作用有关；然而，他汀类药物对HF患者全身炎症的影响尚未明确。我们进行了一项为期16周的单中心、随机、双盲、安慰剂对照、交叉临床试验，研究10毫克/天阿托伐他汀对22例纽约心脏协会II级或III级症状且左心室射血分数<40%的HF患者（包括20例非缺血性HF患者）全身炎症标志物浓度的影响。使用方差分析评估炎症标志物水平变化的绝对值和百分比。他汀类药物治疗使可溶性肿瘤坏死因子受体-1浓度降低132皮克/毫升（p = 0.04）和8%（p = 0.056），C反应蛋白降低1.6毫克/升（p = 0.006）和37%（p = 0.0002），在调整治疗顺序后，内皮素-１降低0.21皮克/毫升（p = 0.007）和17%（p = 0.01）。在事后分析中，肿瘤坏死因子受体-1水平的降低在基线水平升高（达到或高于1055皮克/毫升中位数）的患者中最为显著（p交互作用 = 0.001），其中他汀类药物治疗使该水平降低306皮克/毫升（p <0.001）和22%（p <0.001）。他汀类药物治疗对其他炎症标志物水平，包括白细胞介素-6和脑钠肽，没有显著影响。总之，短期阿托伐他汀治疗降低了HF患者几种重要炎症标志物的水平。
