Raina Amresh, Pickering Thomas, Shimbo Daichi
Behavioral Cardiovascular Health and Hypertension Program, Columbia University Medical Center, New York, NY 10032, USA.
Am Heart J. 2006 Jul;152(1):39-49. doi: 10.1016/j.ahj.2005.09.008.
Statins are effective in the prevention of coronary events and the treatment of acute coronary syndromes. However, their efficacy and safety in patients with heart failure (HF) are unknown. In this review, we discuss the evidence for the efficacy and safety of statin therapy in patients with HF.
We reviewed all original English-language, peer-reviewed journal articles published from 1985 to 2005 obtained from a search of the MEDLINE database. We focused on evidence for the efficacy and safety of statins based on data from patients with HF enrolled in major statin trials, analysis of the impact of statin use in patients with HF, and randomized clinical trials examining the effects of statins on cardiovascular outcomes in patients with HF.
The major primary and secondary prevention statin trials largely excluded patients with HF. Statin use was also limited in randomized HF trials. Subgroup and retrospective analyses, and evidence from prospective cohort studies of statin use in patients with HF suggest statins improve cardiovascular prognosis in HF. The limited small randomized clinical trials also suggest statins improve symptoms, ejection fraction, and inflammatory biomarkers in patients with HF.
A growing weight of evidence suggests that statins have beneficial effects in HF. At this time, there is little evidence to support withdrawing or withholding statins from patients with HF. Ongoing randomized controlled trials that examine the efficacy of statin therapy in patients with HF should clarify the role of these agents in the context of HF.
他汀类药物在预防冠状动脉事件和治疗急性冠状动脉综合征方面有效。然而，其在心力衰竭（HF）患者中的疗效和安全性尚不清楚。在本综述中，我们讨论了他汀类药物治疗HF患者的疗效和安全性证据。
我们检索了MEDLINE数据库，回顾了1985年至2005年发表的所有英文原创、经同行评审的期刊文章。我们基于主要他汀类试验中纳入的HF患者数据、他汀类药物使用对HF患者影响的分析以及检验他汀类药物对HF患者心血管结局影响的随机临床试验，重点关注他汀类药物疗效和安全性的证据。
主要的一级和二级预防他汀类试验大多排除了HF患者。在随机HF试验中，他汀类药物的使用也有限。亚组分析和回顾性分析以及HF患者他汀类药物使用的前瞻性队列研究证据表明，他汀类药物可改善HF患者的心血管预后。有限的小型随机临床试验也表明，他汀类药物可改善HF患者的症状、射血分数和炎症生物标志物。
越来越多的证据表明他汀类药物对HF有益。目前，几乎没有证据支持对HF患者停用或不使用他汀类药物。正在进行的检验他汀类药物治疗HF患者疗效的随机对照试验应阐明这些药物在HF中的作用。
