Folkeringa Richard J, Van Kraaij Dave J, Tieleman Robert G, Nieman Fred H M, Pinto Yigal M, Crijns Harry J G M
Department of Cardiology, University Hospital Maastricht, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
J Card Fail. 2006 Mar;12(2):134-8. doi: 10.1016/j.cardfail.2005.10.014.
Statins may be of potential benefit in patients with congestive heart failure (CHF) due to modulation of neurohormones and their antioxidant, antiinflammatory, and antifibrotic properties. To test this hypothesis, we performed a case-control study by using a prospective registry of patients admitted to our hospital for CHF.
The Maastricht Registry of Congestive Heart Failure consists of a cohort of all patients who were admitted to the University Hospital Maastricht because of CHF for the first time between 1998 and 2000. Elective admissions were not included in the database. Drug treatment was left at the discretion of the attending physician. From a total of 840 patients admitted, we selected patients with an uncomplicated survival for at least 1 month after hospital discharge. For each survivor a nonsurvivor was matched for age, sex, left ventricular ejection fraction, and renal function. Drugs were considered in use only if they were administered for at least 90% of follow-up time. Five hundred twenty-four patients were included with a mean follow-up after discharge of 31 +/- 18 months. Twenty percent used statins. In Cox multivariate regression analysis, the use of statins remained significantly associated with decreased mortality independent of the cause of CHF. However, there appeared no additional benefit of statins in patients using beta-blockers. Mortality rates were constant over time after discharge. Statins were as effective in ischemic as in nonischemic heart failure and in patients with depressed as well as preserved LVEF.
Statins appear associated with improved survival in CHF independent of its etiology. No additional benefit was seen in patients treated with beta-blockers.
他汀类药物可能对充血性心力衰竭（CHF）患者具有潜在益处，因其可调节神经激素，并具有抗氧化、抗炎和抗纤维化特性。为验证这一假设，我们通过对我院因CHF入院患者的前瞻性登记进行了一项病例对照研究。
马斯特里赫特充血性心力衰竭登记处纳入了1998年至2000年间首次因CHF入住马斯特里赫特大学医院的所有患者队列。择期入院患者未纳入数据库。药物治疗由主治医师自行决定。在总共840例入院患者中，我们选择出院后至少存活1个月且病情无并发症的患者。为每例存活者匹配一名年龄、性别、左心室射血分数和肾功能与之相同的非存活者。仅当药物使用时间至少占随访时间的90%时才视为正在使用。共纳入524例患者，出院后平均随访31±18个月。20%的患者使用他汀类药物。在Cox多变量回归分析中，他汀类药物的使用与死亡率降低显著相关，且与CHF病因无关。然而，在使用β受体阻滞剂的患者中，他汀类药物似乎没有额外益处。出院后死亡率随时间保持恒定。他汀类药物在缺血性心力衰竭和非缺血性心力衰竭患者中以及左心室射血分数降低和保留的患者中同样有效。
他汀类药物似乎与CHF患者生存率提高相关，与病因无关。在接受β受体阻滞剂治疗的患者中未观察到额外益处。
