The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials.
The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials.
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DOI：
10.1093/eurheartj/ehv072
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发表时间：
2015-06-21
影响因子：
39.3
通讯作者：
McMurray JJ
中科院分区：
文献类型：
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作者：
Preiss D;Campbell RT;Murray HM;Ford I;Packard CJ;Sattar N;Rahimi K;Colhoun HM;Waters DD;LaRosa JC;Amarenco P;Pedersen TR;Tikkanen MJ;Koren MJ;Poulter NR;Sever PS;Ridker PM;MacFadyen JG;Solomon SD;Davis BR;Simpson LM;Nakamura H;Mizuno K;Marfisi RM;Marchioli R;Tognoni G;Athyros VG;Ray KK;Gotto AM;Clearfield MB;Downs JR;McMurray JJ
他汀类药物对心力衰竭（HF）住院和HF死亡风险的影响仍不确定。我们的目的是确定他汀类药物是否能减少主要的HF事件。我们检索了Medline、EMBASE和科克伦对照试验中心注册中心，以查找1994年至2014年期间的随机对照终点他汀类药物试验。合作试验者提供了来自不良事件报告的未发表数据。我们纳入了一级和二级预防他汀类药物试验，>1000名参与者随访>1年。结局包括首次非致死性HF住院、HF死亡和首次非致死性HF住院或HF死亡的复合终点。排除试验内心肌梗死（MI）后<30天发生的HF事件。我们采用固定效应荟萃分析计算风险比（RR）。在长达4.3年[加权标准差（SD）1.4]的17项试验中，132538名受试者的他汀类药物治疗使LDL-胆固醇降低0.97 mmol/L（加权SD 0.38 mmol/L）。他汀类药物减少了非致命性心力衰竭住院治疗的患者数量（1344/66 238 vs. 1498/66 330; RR 0.90，95%置信区间，CI 0.84-0.97）和复合HF结局（1234/57 734 vs. 1344/57 836; RR 0.92，95% CI 0.85-0.99），但无HF死亡（213/57 734 vs. 220/57 836; RR 0.97，95% CI 0.80-1.17）。他汀类药物对首次非致死性HF住院治疗的影响相似，无论其之前是否有MI（RR 0.87，95% CI 0.68-1.11）（RR 0.91，95% CI 0.84-0.98）。在一级和二级预防试验中，他汀类药物适度降低了非致死性HF住院治疗的风险，以及非致死性HF住院治疗和HF死亡的复合风险，MI患者与非MI患者之间的风险降低无明显差异。
The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events. We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first non-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring <30 days after within-trial myocardial infarction (MI) were excluded. We calculated risk ratios (RR) with fixed-effects meta-analyses. In up to 17 trials with 132 538 participants conducted over 4.3 [weighted standard deviation (SD) 1.4] years, statin therapy reduced LDL-cholesterol by 0.97 mmol/L (weighted SD 0.38 mmol/L). Statins reduced the numbers of patients experiencing non-fatal HF hospitalization (1344/66 238 vs. 1498/66 330; RR 0.90, 95% confidence interval, CI 0.84–0.97) and the composite HF outcome (1234/57 734 vs. 1344/57 836; RR 0.92, 95% CI 0.85–0.99) but not HF death (213/57 734 vs. 220/57 836; RR 0.97, 95% CI 0.80–1.17). The effect of statins on first non-fatal HF hospitalization was similar whether this was preceded by MI (RR 0.87, 95% CI 0.68–1.11) or not (RR 0.91, 95% CI 0.84–0.98). In primary- and secondary-prevention trials, statins modestly reduced the risks of non-fatal HF hospitalization and a composite of non-fatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not.