亲脂性他汀类药物对心力衰竭的影响：13项随机对照试验的荟萃分析。

Effects of lipophilic statins for heart failure: a meta-analysis of 13 randomised controlled trials.

作者信息

Liu Gang, Zheng Xin-Xin, Xu Yan-Lu, Lu Jie, Hui Ru-Tai, Huang Xiao-Hong

机构信息

Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.

出版信息

Heart Lung Circ. 2014 Oct;23(10):970-7. doi: 10.1016/j.hlc.2014.05.005. Epub 2014 May 28.

DOI:10.1016/j.hlc.2014.05.005

PMID:24954758

Abstract

BACKGROUND

The effects of lipophilic statins in heart failure (HF) were controversial. The goal of the present study was to systematically review all randomised controlled trials evaluating the effects of lipophilic statins in patients with HF.

METHODS

We performed a comprehensive literature search to identify eligible trials that prospectively randomised patients with HF to lipophilic statins or control. Primary end points were all-cause mortality, cardiovascular mortality, hospitalisation for worsening HF, left ventricular ejection fraction (LVEF), and low-density lipoprotein cholesterol. Risk ratios (RRs) and Weighted mean differences (WMDs) were calculated using fixed-effects models or random-effects models.

RESULTS

A total of 13 randomised trials with 1,532 subjects were included in this analysis. Ten trials randomised patients to atorvastatin, two to simvastatin, and one to pitavastatin. Overall, lipophilic statins significantly decreased all-cause mortality (RR 0.53, P<0.001), cardiovascular mortality (RR 0.66, P=0.04), and hospitalisation for worsening HF (RR 0.60, P<0.001). Subgroup analyses showed that the effects of lipophilic statins in HF were not modified by age, baseline LVEF, and cause of HF. In addition, patients randomised to lipophilic statins had a significant increase in LVEF (WMD 3.91%, P<0.001) and decrease in low-density lipoprotein cholesterol (WMD 0.90 mmol/L, P<0.001).

CONCLUSIONS

It appears that further studies are needed to determine if lipophilic statins are beneficial for HF patients.

摘要

背景

亲脂性他汀类药物在心力衰竭（HF）中的作用存在争议。本研究的目的是系统评价所有评估亲脂性他汀类药物对HF患者影响的随机对照试验。

方法

我们进行了全面的文献检索，以确定将HF患者前瞻性随机分为亲脂性他汀类药物组或对照组的符合条件的试验。主要终点为全因死亡率、心血管死亡率、因HF恶化住院、左心室射血分数（LVEF）和低密度脂蛋白胆固醇。使用固定效应模型或随机效应模型计算风险比（RRs）和加权平均差（WMDs）。

结果

本分析共纳入13项随机试验，1532名受试者。10项试验将患者随机分为阿托伐他汀组，2项为辛伐他汀组，1项为匹伐他汀组。总体而言，亲脂性他汀类药物显著降低了全因死亡率（RR 0.53，P<0.001）、心血管死亡率（RR 0.66，P=0.04）和因HF恶化住院率（RR 0.60，P<0.001）。亚组分析表明，亲脂性他汀类药物在HF中的作用不受年龄、基线LVEF和HF病因的影响。此外，随机接受亲脂性他汀类药物治疗的患者LVEF显著增加（WMD 3.91%，P<0.001），低密度脂蛋白胆固醇显著降低（WMD 0.90 mmol/L，P<0.001）。