Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Cardiol. 2022 Sep;80(3):226-231. doi: 10.1016/j.jjcc.2022.03.009. Epub 2022 May 21.
Statins are generally used for patients with coronary artery disease. However, the impact of statins in patients with vasospastic angina (VSA) is not fully understood.
In a multicenter registry study of the Japanese Coronary Spasm Association (n = 1429), patients with or without statins were compared. The primary endpoint was major adverse cardiac events (MACEs), defined as cardiac death, non-fatal myocardial infarction, unstable angina, heart failure, and appropriate implantable cardioverter defibrillator shock. Propensity score matching and a multivariable Cox proportional hazard model were used to adjust for selection bias in treatment and potential confounding factors.
In the whole population, 469 patients received statins, while 960 patients did not receive statins. Patients with statins had a greater prevalence of comorbidities, including hypertension, diabetes, dyslipidemia, and smoking, in comparison to those without statins. The prevalence rates of previous myocardial infarction, significant organic stenosis, and medication use (including calcium channel blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, and beta blockers) were greater in patients with statins than in those without statins. After propensity matching (n = 211 for both groups), a Kaplan-Meier curve analysis revealed that the incidence of MACE was comparable between patients with and without statins (p = 0.686). MACEs occurred in 6.0% of patients with statins and in 5.9% of those without statins (p = 0.98).
In this multicenter registry study, statin therapy did not reduce clinical events in VSA patients.
他汀类药物通常用于治疗冠心病患者。然而，他汀类药物在痉挛性心绞痛（VSA）患者中的作用尚未完全明确。
在日本冠状动脉痉挛协会（n=1429）的一项多中心注册研究中，比较了有和无他汀类药物治疗的患者。主要终点为主要不良心脏事件（MACEs），定义为心脏死亡、非致死性心肌梗死、不稳定型心绞痛、心力衰竭和适当的植入式心脏复律除颤器电击。采用倾向评分匹配和多变量 Cox 比例风险模型调整治疗选择偏倚和潜在混杂因素。
在全人群中，469 例患者接受了他汀类药物治疗，960 例患者未接受他汀类药物治疗。与未使用他汀类药物的患者相比，使用他汀类药物的患者合并症（包括高血压、糖尿病、血脂异常和吸烟）的患病率更高。使用他汀类药物的患者既往心肌梗死、显著器质性狭窄和药物治疗（包括钙通道阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和β受体阻滞剂）的患病率更高。在倾向评分匹配后（每组 n=211），Kaplan-Meier 曲线分析显示，使用和未使用他汀类药物的患者 MACE 发生率无差异（p=0.686）。他汀类药物组的 MACE 发生率为 6.0%，无他汀类药物组为 5.9%（p=0.98）。
在这项多中心注册研究中，他汀类药物治疗并未降低 VSA 患者的临床事件发生率。
