Khush Kiran K, Waters David D
Division of Cardiology, University of California, San Francisco School of Medicine, San Francisco, California 94143, USA.
J Card Fail. 2006 Oct;12(8):664-74. doi: 10.1016/j.cardfail.2006.05.003.
Statin therapy has been shown to effectively lower low-density lipoprotein cholesterol levels and reduce cardiovascular events. Statins also appear to exert other favorable effects, including anti-inflammatory actions and improvement in endothelial function. Statin therapy may therefore yield important clinical benefits in patients with heart failure-a physiologic state characterized by systemic inflammation and endothelial dysfunction.
This review summarizes basic and clinical investigations regarding the role of statin therapy in heart failure, focusing on potential mechanisms and preliminary clinical data. There is now extensive evidence suggesting that statins improve endothelial function, inhibit neurohormonal activation, restore autonomic balance, reduce inflammation, and prevent ventricular remodeling. Retrospective and small-scale prospective studies suggest that statins prevent the development of heart failure and reduce mortality in patients with established HF.
Preliminary evidence supports a role for statins in improving surrogate markers and clinical outcomes in ischemic and nonischemic heart failure. Large-scale randomized clinical trials are needed to definitively address this important topic.
他汀类药物治疗已被证明能有效降低低密度脂蛋白胆固醇水平并减少心血管事件。他汀类药物似乎还具有其他有益作用，包括抗炎作用和改善内皮功能。因此，他汀类药物治疗可能会给心力衰竭患者带来重要的临床益处，心力衰竭是一种以全身炎症和内皮功能障碍为特征的生理状态。
本综述总结了关于他汀类药物治疗在心力衰竭中的作用的基础和临床研究，重点关注潜在机制和初步临床数据。现在有大量证据表明，他汀类药物可改善内皮功能、抑制神经激素激活、恢复自主神经平衡、减轻炎症并预防心室重构。回顾性和小规模前瞻性研究表明，他汀类药物可预防心力衰竭的发生并降低已确诊心力衰竭患者的死亡率。
初步证据支持他汀类药物在改善缺血性和非缺血性心力衰竭的替代指标和临床结局方面的作用。需要进行大规模随机临床试验来明确解决这一重要课题。
