Germans Trias i Pujol Health Research Institute, Badalona, Spain.
Mayo Clin Proc. 2012 Jun;87(6):555-60. doi: 10.1016/j.mayocp.2012.02.018.
To assess the relationship between statins and prognosis in ischemic and nonischemic patients with heart failure (HF) in a real-life cohort followed up for a long period.
This prospective study included 960 patients with HF with preserved or depressed left ventricular ejection fraction (LVEF), irrespective of HF etiology, who were referred to the HF clinic of a university hospital between August 1, 2001, and December 31, 2008. The patients were followed up for a maximum of 9.1 years (median, 3.7 years), and survival in ischemic and nonischemic patients was determined.
Median age was 69 years, and median LVEF was 31%. Of the 960 patients, 532 (55.4%) had ischemic HF etiology, and most received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (846; 88.1%) and β-blockers (776; 80.8%). Patients with HF of ischemic origin were more often treated with statins (P<.001). During follow-up, 440 patients (45.8%) died. Statin therapy was associated with significantly improved survival (hazard ratio, 0.45 [95% confidence interval, 0.37-0.54]; P<.001). After adjustment for HF prognostic factors (age, sex, cholesterol level, New York Heart Association class, HF etiology, LVEF, body mass index, HF duration, atrial fibrillation, implantable cardioverter-defibrillator therapy, and medicines), statins remained significantly associated with lower mortality risk in both ischemic (P=.007) and nonischemic (P=.002) patients.
In contrast to results of large randomized trials, statins were independently and significantly associated with lower mortality risk in our real-life HF cohort, including patients with nonischemic HF etiology.
在一个经过长期随访的真实队列中，评估他汀类药物与缺血性和非缺血性心力衰竭（HF）患者预后之间的关系。
这项前瞻性研究纳入了 960 例射血分数保留或降低的 HF 患者（不论 HF 病因如何），这些患者于 2001 年 8 月 1 日至 2008 年 12 月 31 日期间被转诊至一家大学医院的 HF 门诊。患者的随访时间最长为 9.1 年（中位数，3.7 年），并确定了缺血性和非缺血性患者的生存情况。
中位年龄为 69 岁，中位 LVEF 为 31%。在 960 例患者中，532 例（55.4%）有缺血性 HF 病因，大多数患者接受了血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（846 例，88.1%）和β受体阻滞剂（776 例，80.8%）。有缺血性 HF 病因的患者更常接受他汀类药物治疗（P<.001）。在随访期间，440 例患者（45.8%）死亡。他汀类药物治疗与显著改善的生存相关（风险比，0.45[95%置信区间，0.37-0.54]；P<.001）。在校正 HF 预后因素（年龄、性别、胆固醇水平、纽约心脏协会分级、HF 病因、LVEF、体重指数、HF 持续时间、心房颤动、植入式心脏复律除颤器治疗和药物）后，他汀类药物在缺血性（P=.007）和非缺血性（P=.002）患者中均与较低的死亡率风险显著相关。
与大型随机试验的结果相反，在我们的真实 HF 队列中，他汀类药物与较低的死亡率风险独立相关，包括非缺血性 HF 病因的患者。
