Pharmacy Practice & Clinical Pharmacy Department, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, Cairo, Egypt.
Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
Br J Clin Pharmacol. 2021 Jul;87(7):2855-2866. doi: 10.1111/bcp.14695. Epub 2021 Jan 3.
There are insufficient direct comparative studies addressing the impact of the type of statin on their respective efficacy in heart failure (HF). The aim of the current study was to compare the effects of lipophilic (atorvastatin) vs hydrophilic (rosuvastatin) on left ventricular function, inflammatory and fibrosis biomarkers in patients with chronic HF.
This was a prospective, randomized, comparative, parallel study. A total of 85 patients with chronic HF optimized on guideline directed therapy were randomized to receive either atorvastatin 40 mg (n = 42) or rosuvastatin 20 mg (n = 43) for 6 months. Baseline and follow-up assessment included 2D echocardiography, measurement of N-terminal pro-brain natriuretic peptide, interleukin-6 and soluble suppression of tumorigenicity 2 (sST2) levels, liver enzymes and lipid profile.
The increase in left ventricular ejection fraction was significantly higher in the atorvastatin group compared to the rosuvastatin group (6.5% [3-11] vs 4% [2-5], P = .006). The reduction in left ventricular end diastolic and end systolic volume was comparable between the 2 groups. The decrease in sST2 levels in pg/mL was significantly higher in the atorvastatin compared to the rosuvastatin group (-255 [-383 to -109.8 vs - 151 [-216 to -69], P = .003). There was a significant reduction in N-terminal pro-brain natriuretic peptide and interleukin-6 levels in both groups, yet the reduction was comparable in both groups.
The study results suggest that lipophilic atorvastatin is superior to hydrophilic rosuvastatin in increasing left ventricular ejection fraction and reducing fibrosis marker sST2 in HF patients. Trial registration ID: NCT03255044, registered on 21 August 2017.
目前关于他汀类药物对心力衰竭（HF）疗效影响的直接比较研究还不够充分。本研究旨在比较亲脂性阿托伐他汀（atorvastatin）与亲水性瑞舒伐他汀（rosuvastatin）对慢性 HF 患者左心室功能、炎症和纤维化生物标志物的影响。
这是一项前瞻性、随机、对照、平行研究。共纳入 85 例接受指南指导治疗的慢性 HF 优化治疗患者，随机分为阿托伐他汀 40mg 组（n=42）或瑞舒伐他汀 20mg 组（n=43），治疗 6 个月。基线和随访评估包括二维超声心动图、N 末端脑钠肽前体（NT-proBNP）、白细胞介素-6（IL-6）和可溶性生长刺激表达基因 2 蛋白（sST2）水平、肝酶和血脂谱的测量。
与瑞舒伐他汀组相比，阿托伐他汀组左心室射血分数增加更显著（6.5%[3-11]比 4%[2-5]，P=0.006）。两组左心室舒张末期和收缩末期容积的减少相似。阿托伐他汀组 sST2 水平下降更显著（-255[-383 至-109.8]比-151[-216 至-69]，P=0.003）。两组 NT-proBNP 和 IL-6 水平均显著降低，但两组降低幅度相似。
研究结果表明，亲脂性阿托伐他汀在增加慢性 HF 患者的左心室射血分数和降低纤维化标志物 sST2 方面优于亲水性瑞舒伐他汀。试验注册号：NCT03255044，于 2017 年 8 月 21 日注册。
