Ray Joel G, Norris Colleen M, Udell Jacob A, Tsuyuki Ross T, McAlister Finlay A, Knudtson Merril L, Ghali William A
Department of Medicine, Divisions of General Internal Medicine and Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
J Cardiovasc Pharmacol Ther. 2007 Mar;12(1):27-35. doi: 10.1177/1074248407299839.
Lipid-lowering therapy, particularly with statins, reduces the risk of cardiovascular mortality; however, there is uncertainty about their efficacy in patients with heart failure, including those without coronary artery stenosis. A clinical database was studied to determine whether lipid-lowering therapy is associated with improved survival in persons with heart failure-with or without concomitant coronary artery stenosis. During an 8-year period, 6060 people with a history of heart failure underwent coronary angiography. At the time of angiography, 1216 received a lipid-lowering agent. During a median follow-up of 4.7 years, 7.1 deaths per 100 person-years occurred among users of lipid-lowering therapy, compared with 7.8 per 100 person-years among nonusers (adjusted hazard ratio 0.87, 95% confidence interval 0.77-0.97). Use of lipid-lowering therapy was associated with a reduced risk of death in patients with heart failure. Current evidence supports statin use in individuals with recognized heart failure and concomitant coronary heart disease, dyslipidemia, or diabetes mellitus. More data are needed before statins can be recommended in those with isolated heart failure.
降脂治疗，尤其是使用他汀类药物，可降低心血管疾病死亡率；然而，对于心力衰竭患者，包括那些没有冠状动脉狭窄的患者，其疗效尚不确定。一项临床数据库研究旨在确定降脂治疗是否与心力衰竭患者（无论有无合并冠状动脉狭窄）的生存率提高相关。在8年期间，6060名有心力衰竭病史的患者接受了冠状动脉造影。在血管造影时，1216人接受了降脂药物治疗。在中位随访4.7年期间，降脂治疗使用者每100人年有7.1人死亡，而非使用者每100人年有7.8人死亡（调整后的风险比为0.87，95%置信区间为0.77-0.97）。使用降脂治疗与心力衰竭患者死亡风险降低相关。目前的证据支持在已确诊心力衰竭且合并冠心病、血脂异常或糖尿病的个体中使用他汀类药物。在能够推荐他汀类药物用于单纯心力衰竭患者之前，还需要更多的数据。
