Associations of Acid Suppressive Therapy With Cardiac Mortality in Heart Failure Patients.
Associations of Acid Suppressive Therapy With Cardiac Mortality in Heart Failure Patients.
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DOI：
10.1161/jaha.116.005110
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发表时间：
2017-05-16
影响因子：
5.4
通讯作者：
Takeishi Y
中科院分区：
文献类型：
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作者：
Yoshihisa A;Takiguchi M;Kanno Y;Sato A;Yokokawa T;Miura S;Abe S;Misaka T;Sato T;Suzuki S;Oikawa M;Kobayashi A;Yamaki T;Kunii H;Nakazato K;Suzuki H;Saitoh SI;Takeishi Y
最近有报道称，组胺 H2 受体拮抗剂 (H2RA) 与心室重塑受损和心力衰竭有关。此外，质子泵抑制剂（PPI）对心血管疾病的有利多效作用和不利影响也有报道。我们研究了使用 H2RA 或 PPI 进行抑酸治疗与心力衰竭患者心脏死亡率的关系。总共 1191 名连续心力衰竭患者被分为 3 组：非抑酸治疗组（n=363）、H2RA 组（n=164）和 PPI 组（n=664）。在随访期间（平均 995 天），发生了 169 例心源性死亡。在 Kaplan-Meier 分析中，PPI 组的心脏死亡率显着低于 H2RA 组和非酸抑制治疗组（分别为 11.0%、21.3% 和 16.8%；对数秩 P=0.004）。在多变量 Cox 比例风险分析中，发现使用 PPI（而非 H2RA）是心脏死亡率的独立预测因子（PPIs：风险比 0.488，P=0.002；H2RA：风险比 0.855，P=0.579）。倾向匹配的 1:1 队列根据倾向评分进行评估（H2RA，n=164；PPI，n=164）。在匹配后队列中，PPI 组的心脏死亡率显着低于 H2RA 组（对数秩 P=0.025）。在 Cox 比例风险分析中，使用 PPI 是匹配后队列中心脏死亡率的预测因子（风险比 0.528，P=0.028）。 PPI 可能与心力衰竭患者更好的预后相关。
It has been recently reported that histamine H2 receptor antagonists (H2RAs) are associated with impairment of ventricular remodeling and incident heart failure. In addition, favorable pleiotropic effects and adverse effects of proton pump inhibitors (PPIs) on cardiovascular disease have also been reported. We examined the associations of acid suppressive therapy using H2RAs or PPIs with cardiac mortality in patients with heart failure. In total, 1191 consecutive heart failure patients were divided into 3 groups: a non–acid suppressive therapy group (n=363), an H2RA group (n=164), and a PPI group (n=664). In the follow‐up period (mean 995 days), 169 cardiac deaths occurred. In the Kaplan–Meier analysis, cardiac mortality was significantly lower in the PPI group than in the H2RA and non–acid suppressive therapy groups (11.0% versus 21.3% and 16.8%, respectively; log‐rank P=0.004). In the multivariable Cox proportional hazards analysis, use of PPIs, but not H2RAs, was found to be an independent predictor of cardiac mortality (PPIs: hazard ratio 0.488, P=0.002; H2RAs: hazard ratio 0.855, P=0.579). The propensity‐matched 1:1 cohort was assessed based on propensity score (H2RAs, n=164; PPIs, n=164). Cardiac mortality was significantly lower in the PPI group than in the H2RA group in the postmatched cohort (log‐rank P=0.025). In the Cox proportional hazards analysis, the use of PPIs was a predictor of cardiac mortality in the postmatched cohort (hazard ratio 0.528, P=0.028). PPIs may be associated with better outcome in patients with heart failure.