Yamada Takahisa, Node Koichi, Mine Takanao, Morita Takashi, Kioka Hidetaka, Tsukamoto Yasumasa, Tamaki Shunsuke, Masuda Masaharu, Okuda Keiji, Fukunami Masatake
Division of Cardiology, Osaka General Medical Center, Sumiyoshi-ku, Osaka, Japan.
Am Heart J. 2007 Jun;153(6):1055.e1-8. doi: 10.1016/j.ahj.2007.03.027.
Statins have pleiotropic effects, such as improvement in endothelial function and antiinflammatory, antiproliferative, and antioxidative effects, that should be beneficial for patients with chronic heart failure (CHF). The aim of this study was to investigate the long-term effect of statins on neurohumoral activation and cardiac function in patients with CHF.
We enrolled 38 outpatients with mild to moderate CHF and radionuclide left ventricular ejection fraction (LVEF) <40%. These patients were randomly assigned to receive atorvastatin (10 mg/d) or conventional treatment for heart failure and were prospectively followed up for at least 3 years. At entry, we measured plasma concentrations of brain natriuretic peptides (BNPs) and left ventricular end-diastolic dimension and LVEF by echocardiography; thereafter, these measurements were repeated at least every 6 months. The primary end point was defined as the improvement in cardiac function and BNP.
There were no significant differences in age, sex, New York Heart Association class, left ventricular end-diastolic dimension, LVEF, and serum cholesterol level at entry between patients with (n = 19) and without atorvastatin (control, n = 19). After a follow-up period of 31 +/- 14 months, BNP (median [25th, 75th percentile]) significantly decreased in the atorvastatin group (84 [36, 186] to 55 [37, 91] pg/mL, P = .02) but not in the control group. Left ventricular end-diastolic dimension significantly decreased (67.1 [59.9, 70.8] to 61.1 [58, 63.9] mm, P = .02), and LVEF also significantly increased in the atorvastatin group (33.3% +/- 7.4% to 39.1% +/- 12.1%, P = .01) but not in the control group.
Long-term atorvastatin therapy decreases neurohumoral activation and improves cardiac function in patients with mild to moderate CHF.
他汀类药物具有多种效应，如改善内皮功能以及抗炎、抗增殖和抗氧化作用，这些效应可能对慢性心力衰竭（CHF）患者有益。本研究旨在探讨他汀类药物对CHF患者神经体液激活及心脏功能的长期影响。
我们纳入了38例轻度至中度CHF且放射性核素左心室射血分数（LVEF）<40%的门诊患者。这些患者被随机分配接受阿托伐他汀（10mg/d）或心力衰竭常规治疗，并进行前瞻性随访至少3年。入组时，我们通过超声心动图测量血浆脑钠肽（BNP）浓度、左心室舒张末期内径和LVEF；此后，这些测量至少每6个月重复一次。主要终点定义为心脏功能和BNP的改善。
接受阿托伐他汀治疗的患者（n = 19）与未接受阿托伐他汀治疗的患者（对照组，n = 19）在入组时的年龄、性别、纽约心脏协会心功能分级、左心室舒张末期内径、LVEF和血清胆固醇水平方面无显著差异。经过31±14个月的随访，阿托伐他汀组的BNP（中位数[第25百分位数，第75百分位数]）显著降低（从84[36,186]降至55[37,91]pg/mL，P = 0.02），而对照组未降低。阿托伐他汀组的左心室舒张末期内径显著减小（从67.1[59.9,70.8]降至61.1[58,63.9]mm，P = 0.02），LVEF也显著增加（从33.3%±7.4%增至39.1%±12.1%，P = 0.01），而对照组未出现这些变化。
长期阿托伐他汀治疗可降低轻度至中度CHF患者的神经体液激活并改善心脏功能。
