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.

Détails

Ressource 1Télécharger: BIB_C031210DCCFB.pdf (2760.93 [Ko])
Etat: Serval
Version: Final published version
ID Serval
serval:BIB_C031210DCCFB
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
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.
Périodique
PloS one
Auteur(s)
Al-Gobari M., Le H.H., Fall M., Gueyffier F., Burnand B.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Statut éditorial
Publié
Date de publication
2017
Peer-reviewed
Oui
Volume
12
Numéro
2
Pages
e0171168
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis
Publication Status: epublish
Résumé
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.

Mots-clé
Cause of Death, Death, Sudden, Cardiac/epidemiology, Death, Sudden, Cardiac/etiology, Death, Sudden, Cardiac/prevention & control, Heart Failure/complications, Heart Failure/physiopathology, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use, Odds Ratio, Publication Bias, Randomized Controlled Trials as Topic, Stroke Volume, Treatment Outcome
Pubmed
Web of science
Open Access
Oui
Création de la notice
14/02/2017 11:55
Dernière modification de la notice
09/05/2019 0:41
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