No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials.
No benefits of statins for sudden cardiac death prevention in patients with heart failure and reduced ejection fraction: A meta-analysis of randomized controlled trials.
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DOI：
10.1371/journal.pone.0171168
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Burnand B
中科院分区：
文献类型：
--
作者：
Al-Gobari M;Le HH;Fall M;Gueyffier F;Burnand B
他汀类药物在心力衰竭（HF）患者中的结果喜忧参半。在系统性综述和荟萃分析中，主要HF结局（包括全因死亡率和心源性猝死（SCD））的获益始终不一致。我们打算系统地识别和评价现有的证据，评价他汀类药物对HF患者临床结局的有效性。系统性综述和荟萃分析我们检索了Medline、Embase、ISI Web of Science和EBM综述（科克伦DSR、ACP期刊俱乐部、DARE、CCTR、CMR、HTA和NHSEED），直至2016年4月28日，检查了clinicaltrials.gov正在进行的试验，并手动检索了纳入研究的参考文献。我们确定了24项随机临床试验，评估了他汀类药物对HF患者的疗效。对所有随机临床试验的偏倚风险进行评估，并在荟萃分析中汇总。预先规定的结局为心源性猝死、全因死亡和因心力衰竭恶化住院。他汀类药物未降低HF患者的心源性猝死（SCD）事件[相对风险（RR）0.92，95%置信区间（CI）0.70 - 1.21]、全因死亡率[RR 0.88，95% CI 0.75 - 1.02]，但显著降低心力衰竭恶化（HWHF）的住院率，尽管程度有限[RR 0.79，95% CI 0.75 - 1.02]。95% CI 0.66至0.94]。然而，SCD、全因死亡率和HWHF的估计预测区间分别不显著[RR，0.54 - 1.63，0.64 - 1.19和0.54 - 1.15]。一个重要的发现是在HF患者中进行的试验可能存在发表偏倚、小研究效应和异质性。他汀类药物不能降低心力衰竭患者的心源性猝死和全因死亡率，但可略微降低心力衰竭恶化的住院率。对偏倚风险的评估表明，发表的结果质量中等。在获得新证据之前，这项研究支持2013年ACCF/AHA指南，即不要在“仅”HF患者中系统地处方他汀类药物，这应该有助于避免不必要的多药治疗。
Statins showed mixed results in heart failure (HF) patients. The benefits in major HF outcomes, including all-cause mortality and sudden cardiac death (SCD), have always been discordant across systematic reviews and meta-analyses. We intended to systematically identify and appraise the available evidence that evaluated the effectiveness of statins in clinical outcomes for HF patients. Systematic review and meta-analysis We searched, until April 28, 2016: Medline, Embase, ISI Web of Science and EBM reviews (Cochrane DSR, ACP journal club, DARE, CCTR, CMR, HTA, and NHSEED), checked clinicaltrials.gov for ongoing trials and manually searched references of included studies. We identified 24 randomized clinical trials that evaluated the efficacy of statins for HF patients. All randomized clinical trials were assessed for risk of bias and pooled together in a meta-analysis. Pre-specified outcomes were sudden cardiac death, all-cause mortality, and hospitalization for worsening heart failure. Statins did not reduce sudden cardiac death (SCD) events in HF patients [relative risk (RR) 0.92, 95% confidence interval (CI) 0.70 to 1.21], all-cause mortality [RR 0.88, 95% CI 0.75 to 1.02] but significantly reduced hospitalization for worsening heart failure (HWHF) although modestly [RR 0.79, 95% CI 0.66 to 0.94]. Nevertheless, estimated predictive intervals were insignificant in SCD, all-cause mortality and HWHF [RR, 0.54 to 1.63, 0.64 to 1.19, and 0.54 to 1.15], respectively. An important finding was the possible presence of publication bias, small-study effects and heterogeneity of the trials conducted in HF patients. Statins do not reduce sudden cardiac death, all-cause mortality, but may slightly decrease hospitalization for worsening heart failure in HF patients. The evaluation of the risk of biases suggested moderate quality of the published results. Until new evidence is available, this study supports the 2013 ACCF/AHA guidelines to not systematically prescribe statins in “only” HF patients, which should help avoid unnecessary polypharmacy.
DOI：
10.5114/aoms.2010.19293
发表时间：
2010-12
期刊：
Archives of medical science : AMS
影响因子：
--
作者：
Xu M;Yuan G;Wei F
通讯作者：
Wei F