Effect of high-dose atorvastatin on hospitalizations for heart failure - Subgroup analysis of the treating to new targets (TNT) study
Effect of high-dose atorvastatin on hospitalizations for heart failure - Subgroup analysis of the treating to new targets (TNT) study
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DOI：
10.1161/circulationaha.106.625574
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发表时间：
2007-02-06
期刊：
影响因子：
37.8
通讯作者：
Wenger, Nanette K.
中科院分区：
文献类型：
--
作者：
Khush, Kiran K.;Waters, David D.;Wenger, Nanette K.
背景-他汀类药物降低高风险患者的主要心血管事件的发生率，但其作为心力衰竭（HF）治疗的潜在益处尚不清楚。方法和结果-稳定性冠心病患者（n=10 001）随机接受阿托伐他汀80或10 mg/d治疗，随访中位数为4.9年。7.8%的患者有HF病史。已知射血分数< 30%和晚期HF是该研究的排除标准。本研究预定的次要终点是因HF住院。80 mg组和10 mg组因HF住院的发生率分别为2.4%和3.3%（风险比，0.74; 95%置信区间，0.59 - 0.94; P=0.0116）。在有HF病史的患者中，较高剂量的治疗效果更显著：10 mg组和80 mg组分别为17.3%和10.6%（风险比，0.59; 95%置信区间，0.4 - 0.88; P=0.009）。在无HF病史的患者中，HF住院率要低得多：80 mg组为1.8%，10 mg组为2.0%（风险比，0.87; 95%置信区间，0.64 - 1.16; P=0.34）。在研究期间，只有三分之一因HF住院的患者有心绞痛或心肌梗死的证据。血压是几乎相同的后续治疗groups.Conclusions相比，较低的剂量，强化治疗与阿托伐他汀在稳定型冠心病患者显着减少HF住院治疗。在事后分析中，仅在有HF病史的患者中观察到这种获益。解释这种获益的机制不太可能主要是由于中期冠状动脉事件减少或血压差异。
Background - Statins reduce the rate of major cardiovascular events in high-risk patients, but their potential benefit as treatment for heart failure ( HF) is less clear.Methods and Results - Patients (n=10 001) with stable coronary disease were randomized to treatment with atorvastatin 80 or 10 mg/d and followed up for a median of 4.9 years. A history of HF was present in 7.8% of patients. A known ejection fraction < 30% and advanced HF were exclusion criteria for the study. A predefined secondary end point of the study was hospitalization for HF. The incidence of hospitalization for HF was 2.4% in the 80-mg arm and 3.3% in the 10-mg arm (hazard ratio, 0.74; 95% confidence interval, 0.59 to 0.94; P=0.0116). The treatment effect of the higher dose was more marked in patients with a history of HF: 17.3% versus 10.6% in the 10- and 80-mg arms, respectively (hazard ratio, 0.59; 95% confidence interval, 0.4 to 0.88; P=0.009). Among patients without a history of HF, the rates of hospitalization for HF were much lower: 1.8% in the 80-mg group and 2.0% in the 10-mg group (hazard ratio, 0.87; 95% confidence interval, 0.64 to 1.16; P=0.34). Only one third of patients hospitalized for HF had evidence of preceding angina or myocardial infarction during the study period. Blood pressure was almost identical during follow-up in the treatment groups.Conclusions - Compared with a lower dose, intensive treatment with atorvastatin in patients with stable coronary disease significantly reduces hospitalizations for HF. In a post hoc analysis, this benefit was observed only in patients with a history of HF. The mechanism accounting for this benefit is unlikely to be due primarily to a reduction in interim coronary events or differences in blood pressure.