Division of Internal Medicine, Michigan State University, East Lansing, Michigan 48824, USA.
Am J Cardiovasc Drugs. 2010;10(3):155-64. doi: 10.2165/11536690-000000000-00000.
Sudden cardiac death is an important cause of cardiovascular mortality with the majority of cases occurring in low-risk groups. HMG-CoA reductase inhibitors (statins) have recently been shown to reduce the incidence of ventricular tachycardia (VT)/fibrillation (VF) and sudden cardiac death, and this has been attributed to their pleiotropic effects. However, it is unclear whether this occurs through an 'indirect' anti-ischemic or 'direct' antiarrhythmic effect. We systematically reviewed articles published on MEDLINE between January 1996 and December 2009 focusing on the reduction of VT/VF and sudden cardiac death by statins and the potential mechanisms. Studies reporting sudden cardiac death or VT/VF outcomes with statin use (n = 23) or the pathophysiology of sudden cardiac death reduction by statins (n = 19) were included. We found that statins have been shown to reduce VT/VF and sudden cardiac death only in subjects with underlying coronary artery disease or ischemic cardiomyopathy. No definite benefits were seen with statins in sudden cardiac death and VT/VF in patients with non-ischemic cardiomyopathy. There is insufficient evidence to point toward a benefit in populations at low risk for VT/VF. In conclusion, an anti-ischemic rather than a primary antiarrhythmic effect emerges as the likely mechanism of sudden cardiac death reduction with statins.
心脏性猝死是心血管死亡率的一个重要原因，大多数病例发生在低危人群中。HMG-CoA 还原酶抑制剂（他汀类药物）最近被证明可降低室性心动过速（VT）/纤维性颤动（VF）和心脏性猝死的发生率，这归因于其多效性作用。然而，目前尚不清楚这种作用是通过“间接”抗缺血作用还是“直接”抗心律失常作用来实现。我们系统地检索了 1996 年 1 月至 2009 年 12 月在 MEDLINE 上发表的文章，重点关注他汀类药物对 VT/VF 和心脏性猝死的减少作用及其潜在机制。纳入了报告他汀类药物使用与 VT/VF 结局（n=23）或他汀类药物减少心脏性猝死的病理生理学（n=19）相关的研究。我们发现，他汀类药物仅在患有基础冠状动脉疾病或缺血性心肌病的患者中显示出可降低 VT/VF 和心脏性猝死的作用。在非缺血性心肌病患者中，他汀类药物对心脏性猝死和 VT/VF 无明确益处。目前尚缺乏证据表明他汀类药物对 VT/VF 低危人群有益。总之，他汀类药物降低心脏性猝死的机制可能是抗缺血作用，而非主要的抗心律失常作用。
