Martin Jennifer H, Krum Henry
University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
Clin Sci (Lond). 2007 Aug;113(3):119-27. doi: 10.1042/CS20070031.
HMG-CoA (3-hydroxy-3-methylglutaryl-CoA) reductase inhibitors (statins) are well-established therapies in the prevention and treatment of cardiovascular disease, reducing all-cause mortality and cardiovascular events in many disease states. Studies have also suggested that statins given to patients after myocardial infarction improve event-free survival even in short time frames; however, evidence for the benefit of statins in established HF (heart failure) has not been demonstrated with the same rigour of a randomized clinical trial setting. In fact, clinical data examining the effect of statins in HF have been limited by the retrospective or observational nature of these analyses, examination of incompletely validated surrogate end points, small prospective studies in subgroups of HF subjects, and non-uniform doses and different statins being used. In this review, we examine the evidence for the effect of statins on mortality in HF, taking into account theoretical arguments, appropriateness of surrogate markers, animal data and analysis of the predominantly retrospective clinical data that is currently available.
HMG-CoA（3-羟基-3-甲基戊二酰辅酶A）还原酶抑制剂（他汀类药物）是预防和治疗心血管疾病的成熟疗法，可降低多种疾病状态下的全因死亡率和心血管事件。研究还表明，心肌梗死后给予患者他汀类药物即使在短时间内也能改善无事件生存期；然而，他汀类药物对已确诊心力衰竭（HF）有益的证据尚未在同样严格的随机临床试验环境中得到证实。事实上，研究他汀类药物在心力衰竭中作用的临床数据受到这些分析的回顾性或观察性性质、对未完全验证的替代终点的检查、心力衰竭受试者亚组的小型前瞻性研究以及使用的剂量不一致和他汀类药物不同的限制。在本综述中，我们考虑理论依据、替代标志物的适用性、动物数据以及对目前可用的主要回顾性临床数据的分析，来研究他汀类药物对心力衰竭死亡率影响的证据。
