Go Alan S, Lee Wendy Y, Yang Jingrong, Lo Joan C, Gurwitz Jerry H
Division of Research, Kaiser Permanente of Northern California, Oakland 94612, USA.
JAMA. 2006 Nov 1;296(17):2105-11. doi: 10.1001/jama.296.17.2105.
Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.
To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure.
DESIGN, SETTING, AND PATIENTS: Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no previous known statin use, within an integrated health care delivery system in northern California between January 1, 1996, and December 31, 2004. Statin use was estimated from filled outpatient prescriptions in pharmacy databases.
All-cause death and hospitalization for heart failure during a median of 2.4 years of follow-up. We examined the independent relationships between statin therapy and risks for adverse events overall and stratified by the presence or absence of coronary heart disease after multivariable adjustment for potential confounders.
Among 24,598 adults diagnosed with heart failure who had no prior statin use, those initiating statin therapy (n = 12,648; 51.4%) were more likely to be younger, male, and have known cardiovascular disease, diabetes, and hypertension. There were 8235 patients who died. Using an intent-to-treat approach, incident statin use was associated with lower risks of death (age- and sex-adjusted rate of 14.5 per 100 person-years with statin therapy vs 25.3 per 100 person-years without statin therapy; adjusted hazard ratio, 0.76 [95% confidence interval, 0.72-0.80]) and hospitalization for heart failure (age- and sex-adjusted rate of 21.9 per 100 person-years with statin therapy vs 31.1 per 100 person-years without statin therapy; adjusted hazard ratio, 0.79 [95% confidence interval, 0.74-0.85]) even after adjustment for the propensity to take statins, cholesterol level, use of other cardiovascular medications, and other potential confounders. Incident statin use was associated with lower adjusted risks of adverse outcomes in patients with or without known coronary heart disease.
Among adults diagnosed with heart failure who had no prior statin use, incident statin use was independently associated with lower risks of death and hospitalization among patients with or without coronary heart disease.
他汀类药物治疗对心力衰竭患者的临床结局是否具有有益影响尚不清楚。
评估他汀类药物治疗的起始与成年慢性心力衰竭患者的死亡及住院风险之间的关联。
设计、地点和患者：一项倾向得分调整队列研究，研究对象为1996年1月1日至2004年12月31日期间在加利福尼亚州北部一个综合医疗保健系统中被诊断为心力衰竭且符合降脂治疗条件但既往未使用过他汀类药物的成年人。他汀类药物的使用情况根据药房数据库中已配出的门诊处方进行估算。
在中位随访2.4年期间的全因死亡和因心力衰竭住院情况。我们在对潜在混杂因素进行多变量调整后，研究了他汀类药物治疗与总体不良事件风险之间的独立关系，并按有无冠心病进行分层。
在24598名既往未使用过他汀类药物的成年心力衰竭患者中，开始使用他汀类药物治疗的患者（n = 12648；51.4%）更可能年龄较轻、为男性，且患有已知的心血管疾病、糖尿病和高血压。有8235名患者死亡。采用意向性治疗分析方法，新使用他汀类药物与较低的死亡风险相关（年龄和性别调整后的他汀类药物治疗组为每100人年14.5例，未使用他汀类药物治疗组为每100人年25.3例；调整后的风险比为0.76 [95%置信区间为0.72 - 0.80]），以及与较低的因心力衰竭住院风险相关（年龄和性别调整后的他汀类药物治疗组为每100人年21.9例，未使用他汀类药物治疗组为每100人年31.1例；调整后的风险比为0.79 [95%置信区间为0.74 - 0.85]），即使在对使用他汀类药物的倾向、胆固醇水平、其他心血管药物的使用及其他潜在混杂因素进行调整之后也是如此。新使用他汀类药物与有或无已知冠心病患者较低的调整后不良结局风险相关。
在既往未使用过他汀类药物的成年心力衰竭患者中，新使用他汀类药物与有或无冠心病患者较低的死亡和住院风险独立相关。
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