Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial
Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial
复制标题
DOI：
10.1016/s0735-1097(03)00498-4
复制
发表时间：
2003-07-02
影响因子：
24
通讯作者：
Hallstrom, AP
中科院分区：
文献类型：
--
作者：
Mitchell, LB;Powell, JL;Hallstrom, AP
本研究旨在评估降脂药物治疗的抗心律失常作用，通过植入式心律转复除颤器（ICD）记录的动脉粥样硬化性心脏病（ASHD）患者的室性快速性心律失常（室性心动过速[VT]/室颤[VF]）复发来评估降脂药物治疗的抗心律失常作用。因为SD通常继发于VT/VF，方法将在抗心律失常与植入式除颤器（AVID）试验中接受ICD治疗的未接受降脂药物治疗的ASHD患者（n = 279）与接受早期和持续降脂治疗的患者（n = 279）的VT/VF复发概率进行比较。83）。此外，将AVID试验中所有未接受降血脂治疗的ASHD患者（n = 564）的全因死亡率和心源性死亡率与接受早期和持续降脂治疗的患者（n = 149）进行比较。降脂治疗与VT/VF复发的相对危险度降低相关，（95%置信区间[CI] 0.15 - 0.58）（校正后p = 0.003）。降脂治疗也与全因死亡率的相对危险度降低相关，为0.36（95% CI 0.15 - 0.68）（校正p = 0.03），心源性死亡率的相对风险降低0.39（95% CI 0.16至0.78）结论：在接受ICD的ASHD患者中，降脂治疗与VT/VF复发概率的降低相关，提示降脂治疗的部分益处可能是由于抗肿瘤作用。(C)2003年由美国心脏病学会基金会。
OBJECTIVES This study sought to evaluate the antiarrhythmic effects of lipid-lowering drug therapy as assessed by ventricular tachyarrhythmia (ventricular tachycardia [VT]/ventricular fibrillation [VF]) recurrences recorded by an implantable cardioverter defibrillator (ICD) in patients with atherosclerotic heart disease (ASHD).BACKGROUND Randomized trials of lipid-lowering drugs suggest reduction of sudden death (SD) in patients with ASHD. Because SD is usually secondary to VT/VF, this observation suggests that lipid-lowering therapy has antiarrhythmic effects.METHODS The probability of VT/VF recurrence in patients with ASHD treated with an ICD in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial who did not receive lipid-lowering drug therapy (n = 279) was compared with that in patients who received early and consistent lipid-lowering therapy (n = 83). In addition, all-cause mortality and cardiac mortality of all patients in the AVID trial with ASHD who did not receive Epid-lowering therapy (n = 564) were compared with that of those who received early and consistent lipid-lowering therapy (n = 149).RESULTS Using multivariate analyses, lipid-lowering therapy was associated with a reduction in the relative hazard for VT/VF recurrence of 0.40 (95% confidence interval [CI] 0.15 to 0.58) (adjusted p = 0.003) in the ICD subgroup. Lipid-lowering therapy was also associated with a reduction in the relative hazard for all-cause mortality of 0.36 (95% CI 0.15 to 0.68) (adjusted p = 0.03) and a reduction in the relative hazard for cardiac mortality of 0.39 (95% CI 0.16 to 0.78) (adjusted p = 0.04) in the larger study population.CONCLUSIONS In patients with ASHD who have received an ICD, lipid-lowering therapy is associated with reduction in the probability of VT/VF recurrence, suggesting that part of the benefit of lipid-lowering therapy may be due to an antiarrhythmic effect. (C) 2003 by the American College of Cardiology Foundation.