Division of Cardiology, Department of Medicine The University of Hong Kong Shen Zhen Hospital Hong Kong China.
Division of Cardiology, Department of Medicine The University of Hong Kong, Queen Mary Hospital Hong Kong China.
J Am Heart Assoc. 2023 Dec 5;12(23):e032378. doi: 10.1161/JAHA.123.032378. Epub 2023 Nov 28.
Whether statin use can reduce the risk of heart failure (HF) remains controversial. The present study evaluates the association between statin use and HF in patients with atrial fibrillation.
Patients with newly diagnosed atrial fibrillation from 2010 to 2018 were included. An inverse probability of treatment weighting was used to balance baseline covariates between statin users (n=23 239) and statin nonusers (n=29 251). The primary outcome was incident HF. Cox proportional hazard models with competing risk regression were used to evaluate the risk of HF between statin users and nonusers. The median age of the cohort was 74.7 years, and 47.3% were women. Over a median follow-up of 5.1 years, incident HF occurred in 3673 (15.8%) statin users and 5595 (19.1%) statin nonusers. Statin use was associated with a 19% lower risk of HF (adjusted subdistribution hazard ratio, 0.81 [95% CI, 0.78-0.85]). Restricted to the statin users, duration of statin use was measured during follow-up; compared with short-term use (3 months to <2 years), there was a stepwise reduction in the risk of incident HF among those with 2 to <4 years of statin use (subdistribution hazard ratio, 0.86 [95% CI, 0.84-0.88]), 4 to <6 years of statin use (subdistribution hazard ratio, 0.74 [95% CI, 0.72-0.76]), and ≥6 years of statin use (subdistribution hazard ratio, 0.71 [95% CI, 0.69-0.74]). Subgroup analysis showed consistent reductions in the risk of HF with statin use.
Statin use was associated with a decreased risk of incident HF in a duration-dependent manner among patients with atrial fibrillation.
他汀类药物的使用是否可以降低心力衰竭（HF）的风险仍存在争议。本研究评估了他汀类药物的使用与心房颤动患者 HF 之间的相关性。
纳入了 2010 年至 2018 年新诊断为心房颤动的患者。使用逆概率治疗加权法在他汀类药物使用者（n=23239）和他汀类药物非使用者（n=29251）之间平衡基线协变量。主要结局是发生 HF。使用竞争风险回归的 Cox 比例风险模型评估他汀类药物使用者和非使用者之间 HF 的风险。队列的中位年龄为 74.7 岁，47.3%为女性。中位随访时间为 5.1 年后，3673 例（15.8%）他汀类药物使用者和 5595 例（19.1%）他汀类药物非使用者发生 HF。他汀类药物的使用与 HF 风险降低 19%相关（调整后的亚分布危险比，0.81[95%CI，0.78-0.85]）。在仅限于他汀类药物使用者的情况下，在随访期间测量了他汀类药物使用的持续时间；与短期使用（3 个月至<2 年）相比，他汀类药物使用 2 至<4 年（亚分布危险比，0.86[95%CI，0.84-0.88]）、4 至<6 年（亚分布危险比，0.74[95%CI，0.72-0.76]）和≥6 年（亚分布危险比，0.71[95%CI，0.69-0.74]）的患者发生 HF 的风险呈逐步降低。亚组分析显示，他汀类药物的使用与 HF 风险降低呈剂量依赖性。
在心房颤动患者中，他汀类药物的使用与 HF 风险呈剂量依赖性降低相关。
