Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
Int J Cardiol. 2018 Mar 15;255:111-117. doi: 10.1016/j.ijcard.2017.12.109. Epub 2018 Jan 4.
The effects of statins in patients with heart failure with preserved ejection fraction (HFpEF) remain unclear. This study aimed to assess whether statin therapy is associated with a decreased risk of mortality in patients with HFpEF.
We used data from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. The primary outcome was all-cause mortality. We analyzed hazard ratios (HRs) for outcomes with 95% confidence intervals (95% CIs) in patients taking statins compared with those not taking statins using multivariable Cox proportional hazard models.
This study included 3378 patients with HFpEF. The mean follow-up period was 3.3years; 497 patients died during the study period. Among all patients, the adjusted HR for all-cause death was significantly lower in those taking statins compared with those not taking statins (HR 0.79, 95% CI 0.63-0.99, P=0.04). The risks of all-cause and cardiovascular mortality in patients without ischemic heart disease (IHD) were significantly lower in those taking statins compared with those not taking statins (HR 0.63, 95% CI 0.44-0.91, P=0.01 and HR 0.59, 95% CI 0.37-0.94, P=0.02, respectively), whereas the risks in patients with IHD did not differ significantly between those taking and not taking statins (HR 0.97, 95% CI 0.72-1.31, P=0.83 and HR 0.95, 95% CI 0.66-1.36, P=0.77, respectively). Among propensity score-matched patients without IHD, the risks of all-cause and cardiovascular death were significantly lower in those taking statins compared with those not taking statins.
Statin therapy was associated with improved outcomes in HFpEF patients, particularly those without IHD.
他汀类药物在射血分数保留型心力衰竭（HFpEF）患者中的作用尚不清楚。本研究旨在评估他汀类药物治疗是否与 HFpEF 患者的死亡率降低相关。
我们使用了来自治疗保留心功能心力衰竭的醛固酮拮抗剂（TOPCAT）试验的数据。主要结局是全因死亡率。我们使用多变量 Cox 比例风险模型分析了服用他汀类药物的患者与未服用他汀类药物的患者之间结局的风险比（HR）及其 95%置信区间（95%CI）。
本研究纳入了 3378 例 HFpEF 患者。平均随访时间为 3.3 年；研究期间有 497 例患者死亡。在所有患者中，与未服用他汀类药物的患者相比，服用他汀类药物的患者全因死亡的调整 HR 显著降低（HR 0.79，95%CI 0.63-0.99，P=0.04）。在无缺血性心脏病（IHD）的患者中，服用他汀类药物的患者全因和心血管死亡率的风险显著降低（HR 0.63，95%CI 0.44-0.91，P=0.01 和 HR 0.59，95%CI 0.37-0.94，P=0.02），而 IHD 患者服用和未服用他汀类药物的患者之间的风险无显著差异（HR 0.97，95%CI 0.72-1.31，P=0.83 和 HR 0.95，95%CI 0.66-1.36，P=0.77）。在无 IHD 的倾向评分匹配患者中，与未服用他汀类药物的患者相比，服用他汀类药物的患者全因和心血管死亡的风险显著降低。
他汀类药物治疗与 HFpEF 患者的结局改善相关，特别是无 IHD 的患者。
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