I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Pharmacol Res. 2021 Mar;165:105418. doi: 10.1016/j.phrs.2021.105418. Epub 2021 Jan 13.
Statins are effective for reducing cardiovascular disease in patients at risk or with cardiovascular disease. The benefit of statin therapy on adverse cardiovascular outcomes in patients with non-valvular atrial fibrillation (AF) is not clear. We performed a systematic review and meta-analysis of studies retrieved from MEDLINE via PubMed and Cochrane (CENTRAL) database of studies investigating the efficacy of statins in AF patients. The principal endpoint was all-cause mortality. Other endpoints were cardiovascular mortality, ischemic stroke, composite endpoints and any bleeding. We included 14 studies (2 post-hoc analysis of randomized clinical trials, 8 prospective and 4 retrospective) with 100,287 AF patients, of whom 23,228 were on statins. The pooled hazard ratio (HR) for all-cause mortality was 0.59 (95 % Confidence Interval [CI] 0.54-0.65). This association was consistent by aging, sex and prevalent cardiovascular or cerebrovascular disease. and the beneficial effect was evident already after 12 months of therapy. The absolute risk reduction for all-cause mortality in patients treated with statins was 10 % (95 % CI 9-10). The pooled HR for statins against cardiovascular mortality was 0.75 (95 % CI 0.58-0.96). No association was found with other secondary endpoints. Regarding bleeding events, the pooled HR for statin use was 0.60 (95 % CI 0.48-0.76). Our meta-analysis shows that in AF patients, statin therapy was associated with a reduction in all-cause and cardiovascular mortality are reduced by 41 % and 25 %, respectively. Randomized clinical trials in AF patients are necessary, as well as clarity on AF-specific LDL cholesterol targets.
他汀类药物可有效降低心血管疾病风险患者或已患心血管疾病患者的心血管疾病风险。他汀类药物治疗对非瓣膜性心房颤动（AF）患者不良心血管结局的影响尚不清楚。我们通过 PubMed 中的 MEDLINE 和 Cochrane（CENTRAL）数据库系统地检索了研究他汀类药物在 AF 患者中的疗效的研究，并进行了荟萃分析。主要终点是全因死亡率。其他终点是心血管死亡率、缺血性卒中和复合终点以及任何出血事件。我们纳入了 14 项研究（2 项为随机临床试验的事后分析，8 项为前瞻性研究，4 项为回顾性研究），共纳入 100287 例 AF 患者，其中 23228 例患者接受了他汀类药物治疗。全因死亡率的合并风险比（HR）为 0.59（95%置信区间[CI]0.54-0.65）。这种相关性在年龄、性别以及是否存在心血管或脑血管疾病方面是一致的，而且在治疗 12 个月后就出现了有益效果。接受他汀类药物治疗的患者全因死亡率的绝对风险降低了 10%（95%CI9-10）。他汀类药物对心血管死亡率的 HR 为 0.75（95%CI0.58-0.96）。其他次要终点未发现相关性。关于出血事件，他汀类药物使用的合并 HR 为 0.60（95%CI0.48-0.76）。我们的荟萃分析表明，在 AF 患者中，他汀类药物治疗与全因死亡率和心血管死亡率降低相关，分别降低了 41%和 25%。需要在 AF 患者中开展随机临床试验，并明确 AF 患者的 LDL 胆固醇特定目标。
