Prognostic Impact of Statin Intensity in Heart Failure Patients With Ischemic Heart Disease: A Report From the CHART-2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2) Study.
Prognostic Impact of Statin Intensity in Heart Failure Patients With Ischemic Heart Disease: A Report From the CHART-2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2) Study.
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DOI：
10.1161/jaha.117.007524
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发表时间：
2018-03-14
影响因子：
5.4
通讯作者：
CHART‐2 invesigators
中科院分区：
文献类型：
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作者：
Oikawa T;Sakata Y;Nochioka K;Miura M;Tsuji K;Onose T;Abe R;Kasahara S;Sato M;Shiroto T;Takahashi J;Miyata S;Shimokawa H;CHART‐2 invesigators
他汀类药物对缺血性心脏病患者的预后有益，但对心力衰竭（HF）患者的预后无影响。此外，目前尚不清楚患者是否受益于他汀类药物，无论低密度脂蛋白胆固醇水平如何。我们检查了2444例在CHART-2（日本东北地区2区慢性心力衰竭登记和分析）中登记的连续C期或D期缺血性心脏病HF患者，这是一项在日本进行的多中心、前瞻性、观察性队列研究。根据2013年美国心脏病学会和美国心脏协会指南定义的他汀类药物日本标准剂量和他汀类药物强度类别，将患者分为3组：高（中-高）强度（n=868）、低（低）强度（n=526）和无他汀类药物（n=1050）。中位随访期为6.4年（13929人年）。使用多种治疗倾向评分加权的治疗逆概率分析显示，与无他汀组相比，高强度组（风险比[HR]：0.68; P<0.001）和低强度组（HR：0.82; P<0.001）的主要终点（全因死亡和HF入院的复合终点）发生率显著降低。与低强度他汀类药物组相比，高强度他汀类药物组的主要终点（HR：0.82; P<0.001）、全因死亡（HR：0.83; P<0.001）和HF入院（HR：0.78; P<0.001）的发生率显著降低。此外，无论低密度脂蛋白胆固醇水平如何，他汀类药物的使用，无论是高强度还是低强度，都与主要终点的发生率降低相关。这些结果表明，无论低密度脂蛋白胆固醇水平如何，他汀类药物的使用，特别是高强度他汀类药物的使用，对缺血性心脏病HF患者的预后具有有益的影响。 URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00418041。
The beneficial prognostic impact of statins has been established in patients with ischemic heart disease but not in those with heart failure (HF). In addition, it is still unclear whether patients benefit from statins regardless of low‐density lipoprotein cholesterol levels. We examined 2444 consecutive stage C or D HF patients with ischemic heart disease registered in CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2), a multicenter, prospective, observational cohort study in Japan. Patients were divided into 3 groups according to the Japanese standard doses of statins and statin‐intensity categories defined by the 2013 American College of Cardiology and American Heart Association guidelines: higher (moderate‐high)‐intensity (n=868), lower (low)‐intensity (n=526), and no statin (n=1050). The median follow‐up period was 6.4 years (13929 person‐years). Analysis with the inverse probability of treatment weighted using a propensity score for multiple treatment revealed that both the higher‐intesity group (hazard ratio [HR]: 0.68; P<0.001) and the lower‐intensity group (HR: 0.82; P<0.001) had significantly lower incidence of the primary end point—a composite of all‐cause death and HF admission—compared with the no statin group. The higher‐intensity statin group had significantly lower incidence of the primary end point (HR: 0.82; P<0.001), all‐cause death (HR: 0.83; P<0.001), and HF admission (HR: 0.78; P<0.001) than the lower‐intensity statin group. Moreover, the use of statins, either higher‐ or lower‐intensity, was associated with reduced incidence of the primary end point, regardless of low‐density lipoprotein cholesterol levels. These results suggest that statin use, particularly the use of higher‐intensity statins, has a beneficial prognostic impact in HF patients with ischemic heart disease, regardless of low‐density lipoprotein cholesterol levels. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00418041.