Li Xu, Liu Xing-peng, Liu Xiao-hui, Du Xin, Kang Jun-ping, Lü Qiang, Wang Hai-yun, Xu Xia, Liang Cui, Yan Qian, Lei Tao, Geng Li-li, Liu Bai-qiu, Ma Chang-sheng
Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Science, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2010 Jul 27;90(28):1974-7.
To explore the effect of early statin therapy (atorvastatin and simvastatin) on mortality in patients with non-ischemic dilated cardiomyopathy.
A retrospective study was conducted at a single center. A total of 315 patients with non-ischemic dilated cardiomyopathy, admitted into our hospital from January 2002 to December 2008, were enrolled. The association of statin therapy at the initial hospitalization with all-cause mortality was evaluated. The median follow-up period was 45.1 months.
By the single-factor analysis, we found that the follow-up mortality was 17.2% in statin group and it was significantly lower than 37.4% of non-statin users (P = 0.003); in patients with worsening cardiac function NYHA III - IV, the mortality of statin group was 17.2% while a much higher mortality of 47.4% was found in non-statin users (P = 0.003); in patients with NYHA I - II, no significant difference was found in mortality between two groups. By the multi-factor analysis adjusting for age, gender, history of hypertension, diabetes mellitus, current cigarette smoking, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, left ventricular ejection fraction, NYHA functional class, use of angiotensin-converting enzyme inhibitor, β blocker, aldosterone, other diuretics, digoxin and calcium channel blocker, we found the relative risk (RR) of death in statin use was 0.352 (95%CI 0.135 - 0.920, P = 0.033). In patients with NYHA III - IV, the relative death risk of statin therapy was 0.250 (95%CI 0.081 - 0.778, P = 0.017).
Early treatment of atorvastatin or simvastatin is closely correlated with the reduction of mortality in non-ischemic dilated cardiomyopathy patients, especially in those with severe heart failure. And the correlation is independent of the lipid-lowering effects of statins, ACEI and β-blocker therapy.
探讨早期他汀类药物治疗（阿托伐他汀和辛伐他汀）对非缺血性扩张型心肌病患者死亡率的影响。
在单一中心进行一项回顾性研究。纳入2002年1月至2008年12月期间我院收治的315例非缺血性扩张型心肌病患者。评估首次住院时他汀类药物治疗与全因死亡率的相关性。中位随访期为45.1个月。
单因素分析发现，他汀类药物治疗组的随访死亡率为17.2%，显著低于非他汀类药物使用者的37.4%（P = 0.003）；在心功能恶化至纽约心脏协会（NYHA）III - IV级的患者中，他汀类药物治疗组的死亡率为17.2%，而非他汀类药物使用者的死亡率高达47.4%（P = 0.003）；在NYHA I - II级的患者中，两组死亡率无显著差异。多因素分析校正年龄、性别、高血压病史、糖尿病史、当前吸烟情况、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、左心室射血分数、NYHA心功能分级、血管紧张素转换酶抑制剂的使用、β受体阻滞剂、醛固酮、其他利尿剂、地高辛和钙通道阻滞剂后，我们发现使用他汀类药物的死亡相对风险（RR）为0.352（95%可信区间0.135 - 0.920，P = 0.033）。在NYHA III - IV级的患者中，他汀类药物治疗的相对死亡风险为0.250（95%可信区间0.081 - 0.778，P = 0.017）。
早期使用阿托伐他汀或辛伐他汀治疗与非缺血性扩张型心肌病患者死亡率的降低密切相关，尤其是在重度心力衰竭患者中。并且这种相关性独立于他汀类药物的降脂作用、ACEI和β受体阻滞剂治疗。
