The causal effects of statins to the prognosis of chronic heart failure_Chinese Journal of Evidence-Based Medicine

Authors：

TIAN Jing ^1,2 , DU Yutao ³ , WANG Yujing ³ , ZHANG Yajing ¹ , YAN Jingjing ³ ,  HAN Qinghua ¹ ,  ZHANG Yanbo ^2,3,4

1. Department of Cardiology, the First Hospital of Shanxi Medical University, Taiyuan 030001, P. R. China;
2. Department of Statistics, Shanxi Medical University, Taiyuan 030001, P. R. China;
3. Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan 030001, P. R. China;
4. Shanxi University of Chinese Medicine, Taiyuan 030001, P. R. China;

Corresponding author：

HAN Qinghua, Email: syhqh@sohu.com; ZHANG Yanbo, Email: sxmuzyb@126.com

Keywords：

Chronic heart failure; Statins; Marginal structural model

DOI：

10.7507/1672-2531.202211137

Video：

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Objective To evaluate the effect of statins on amino-terminal brain natriuretic peptide (NT-proBNP), grade of New York Heart Association (NYHA), and ejection fraction (EF) in patients with chronic heart failure (CHF) using marginal structural model. Methods A total of 297 patients with CHF from two medical centers in Shanxi province were sequentially enrolled from January 2018 to December 2020. The medical records were collected. Confounding factors were analyzed by t-test, Chi-square test and logistic regression. The random forest algorithm was used to estimate the weight of inverse probability. The marginal structural model was applied to evaluate the effects of statins. Results Using logistic regression to exclude the influence of baseline confounders, the results showed that statins had no significant effect on the level of NT-proBNP in patients with CHF. The marginal structural model which excluded the influence of baseline confounders, time-dependent confounders and treatment conversion factors showed that statins significantly reduced NT-proBNP (OR=0.699, 95%CI 0.528 to 0.926, P=0.012). Statins had no significant effects on NYHA and EF. Conclusion Statins can effectively reduce the level of NT-proBNP in patients with CHF.

Citation： TIAN Jing, DU Yutao, WANG Yujing, ZHANG Yajing, YAN Jingjing, HAN Qinghua, ZHANG Yanbo. The causal effects of statins to the prognosis of chronic heart failure. Chinese Journal of Evidence-Based Medicine, 2023, 23(6): 621-626. doi: 10.7507/1672-2531.202211137 Copy

1.	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要. 中国循环杂志, 2022, 37(6): 553-578.
2.	Bielecka-Dabrowa A, Bytyçi I, Von Haehling S, et al. Association of statin use and clinical outcomes in heart failure patients: a systematic review and meta-analysis. Lipids Health Dis, 2019, 18(1): 188.
3.	Cook JA, Hislop J, Adewuyi TE, et al. Assessing methods to specify the target difference for a randomised controlled trial: DELTA (Difference ELicitation in TriAls) review. Health Technol Assess, 2014, 18(28): 1v-175v.
4.	Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol, 2013, 24(3): 465-473.
5.	何文强, 姚丹霖, 王新建, 等. 基于XML的电子病历系统的研究与实现. 计算机与信息技术, 2005, (1): 46-48.
6.	Robins JM, Hernán MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology, 2000, 11(5): 550-560.
7.	Williamson T, Ravani P. Marginal structural models in clinical research: when and how to use them. Nephrol Dial Transplant, 2017, 32(suppl 2): ii84-ii90.
8.	Newton R, Wernisch L. A comparison of machine learning and Bayesian modelling for molecular serotyping. BMC Genomics, 2017, 18(1): 606.
9.	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心血管病杂志, 2018, 46(10): 760-789.
10.	Mortimer KM, Neugebauer R, van der Laan M, et al. An application of model-fitting procedures for marginal structural models. Am J Epidemiol, 2005, 162(4): 382-388.
11.	朱敏. 逆概率加权方法在医学研究中的应用. 上海: 复旦大学, 2012.
12.	张天一, 叶小飞, 张新佶, 等. 边缘结构模型—一种控制时依性混杂的方法. 中国卫生统计, 2015, 32(1): 171-173,176.
13.	陈晨鑫, 郭晓晶, 许金芳, 等. 基于SuperLearner的边缘结构模型研究及发展. 药物流行病学杂志, 2022, 31(2): 101-106.
14.	Andreou I, Tousoulis D, Miliou A, et al. Effects of rosuvastatin on myeloperoxidase levels in patients with chronic heart failure: a randomized placebo-controlled study. Atherosclerosis, 2010, 210(1): 194-198.
15.	Abulhul E, McDonald K, Martos R, et al. Long-term statin therapy in patients with systolic heart failure and normal cholesterol: effects on elevated serum markers of collagen turnover, inflammation, and B-type natriuretic peptide. Clin Ther, 2012, 34(1): 91-100.
16.	Broch K, Askevold ET, Gjertsen E, et al. The effect of rosuvastatin on inflammation, matrix turnover and left ventricular remodeling in dilated cardiomyopathy: a randomized, controlled trial. PLoS One, 2014, 9(2): e89732.
17.	Vrtovec B, Okrajsek R, Golicnik A, et al. Atorvastatin therapy may reduce the incidence of sudden cardiac death in patients with advanced chronic heart failure. J Card Fail, 2008, 14(2): 140-144.
18.	Tsutamoto T, Yamaji M, Kawahara C, et al. Effect of simvastatin vs. rosuvastatin on adiponectin and haemoglobin A1c levels in patients with non-ischaemic chronic heart failure. Eur J Heart Fail, 2009, 11(12): 1195-1201.
19.	Wang D, Bai L, Cui XR, et al. Effectiveness of atorvastatin in the treatment of asymptomatic heart failure after myocardial infarction: a clinical study. Adv Ther, 2020, 37(11): 4649-4659.
20.	Tousoulis D, Oikonomou E, Siasos G, et al. Dose-dependent effects of short term atorvastatin treatment on arterial wall properties and on indices of left ventricular remodeling in ischemic heart failure. Atherosclerosis, 2013, 227(2): 367-372.

1. 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要. 中国循环杂志, 2022, 37(6): 553-578.
2. Bielecka-Dabrowa A, Bytyçi I, Von Haehling S, et al. Association of statin use and clinical outcomes in heart failure patients: a systematic review and meta-analysis. Lipids Health Dis, 2019, 18(1): 188.
3. Cook JA, Hislop J, Adewuyi TE, et al. Assessing methods to specify the target difference for a randomised controlled trial: DELTA (Difference ELicitation in TriAls) review. Health Technol Assess, 2014, 18(28): 1v-175v.
4. Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol, 2013, 24(3): 465-473.
5. 何文强, 姚丹霖, 王新建, 等. 基于XML的电子病历系统的研究与实现. 计算机与信息技术, 2005, (1): 46-48.
6. Robins JM, Hernán MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology, 2000, 11(5): 550-560.
7. Williamson T, Ravani P. Marginal structural models in clinical research: when and how to use them. Nephrol Dial Transplant, 2017, 32(suppl 2): ii84-ii90.
8. Newton R, Wernisch L. A comparison of machine learning and Bayesian modelling for molecular serotyping. BMC Genomics, 2017, 18(1): 606.
9. 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心血管病杂志, 2018, 46(10): 760-789.
10. Mortimer KM, Neugebauer R, van der Laan M, et al. An application of model-fitting procedures for marginal structural models. Am J Epidemiol, 2005, 162(4): 382-388.
11. 朱敏. 逆概率加权方法在医学研究中的应用. 上海: 复旦大学, 2012.
12. 张天一, 叶小飞, 张新佶, 等. 边缘结构模型—一种控制时依性混杂的方法. 中国卫生统计, 2015, 32(1): 171-173,176.
13. 陈晨鑫, 郭晓晶, 许金芳, 等. 基于SuperLearner的边缘结构模型研究及发展. 药物流行病学杂志, 2022, 31(2): 101-106.
14. Andreou I, Tousoulis D, Miliou A, et al. Effects of rosuvastatin on myeloperoxidase levels in patients with chronic heart failure: a randomized placebo-controlled study. Atherosclerosis, 2010, 210(1): 194-198.
15. Abulhul E, McDonald K, Martos R, et al. Long-term statin therapy in patients with systolic heart failure and normal cholesterol: effects on elevated serum markers of collagen turnover, inflammation, and B-type natriuretic peptide. Clin Ther, 2012, 34(1): 91-100.
16. Broch K, Askevold ET, Gjertsen E, et al. The effect of rosuvastatin on inflammation, matrix turnover and left ventricular remodeling in dilated cardiomyopathy: a randomized, controlled trial. PLoS One, 2014, 9(2): e89732.
17. Vrtovec B, Okrajsek R, Golicnik A, et al. Atorvastatin therapy may reduce the incidence of sudden cardiac death in patients with advanced chronic heart failure. J Card Fail, 2008, 14(2): 140-144.
18. Tsutamoto T, Yamaji M, Kawahara C, et al. Effect of simvastatin vs. rosuvastatin on adiponectin and haemoglobin A1c levels in patients with non-ischaemic chronic heart failure. Eur J Heart Fail, 2009, 11(12): 1195-1201.
19. Wang D, Bai L, Cui XR, et al. Effectiveness of atorvastatin in the treatment of asymptomatic heart failure after myocardial infarction: a clinical study. Adv Ther, 2020, 37(11): 4649-4659.
20. Tousoulis D, Oikonomou E, Siasos G, et al. Dose-dependent effects of short term atorvastatin treatment on arterial wall properties and on indices of left ventricular remodeling in ischemic heart failure. Atherosclerosis, 2013, 227(2): 367-372.

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