Meta-Analysis Of The Effect Of Statins On Prognosis In Patients With Preserved Ejection Fraction

Objectives:We aimed to conduct a meta-analysis of published studies examining the effect of statins on all-cause mortality,cardiovascular mortality and rehospitalization rate in HFpEF and provides evidence-based clinical application for statins in patients with HFpEF.Methods:We searched Embase,PubMed,Cochrane Library,CNKI and Wanfang.We included studys trials which evaluate the differences of all-cause mortality between HFpEF patients without and with statins.The eligible studies were selected and then extracted relevant information,according to pre-set inclusion criteria and extraction criteria for meta-analysis.The data was combined with random-effects model or fixed-effects model based on heterogeneity.The effect values was expressed as relative risk(RR)and 95%confidence interval(CI).Heterogeneity was quantified by I~2.The subgroup analysis,sensitivity analysis and bias analysis were also performed.Results:There were 10 literatures met a criterion analyzed.A total of 29487 patients involved were divided into two groups:treatment group included 11858 patients and control group included 17629 patients.The pooled analysis showed that statin therapy was associated with reduced all-cause mortality in patients with HFpEF.(RR 0.51,95%CI0.38 to 0.65,p<0.01).Due to significant heterogeneity,Subgroup analysis was performed.After categoried by age,region and study design,significant heterogeneity was found in two subgroups.Nevertheless,after categoried by study quality,no significant heterogeneity was found in two subgroups.Thus study quality may be the main source of heterogeneity.In sensitivity analysis,the RRs were similar without great fluctuation.The funnel plot was asymmetrical and the Egger’s test showed p=0.003,which suggested that there may be bias in the study.The effect of statins on cardiovascular mortality and heart failure rehospitalization rate in patients with HFpEF remain inconclusive due to the limitation of literature quantity and sample size.Only the corresponding effect values of the relevant literature were described.The effect values of cardiovascular mortality in the relevant literature were 0.86(0.75,0.98),0.29(0.21,0.37),and 0.33(0.07,1.58),respectively.The effect values of heart failure rehospitalization rate in the relevant literature were 0.73(0.65,0.82),0.06(0.02,0.15),and 0.96(0.69,1.34),respectively.Conclusion:Statin therapy may be associated with decreased all-cause mortality in patients with HFpEF.However randomized controlled trials are needed to confirm the efficacy of statins in HFPEF.The effect of statins on cardiovascular mortality and heart failure rehospitalization rate in patients with HFpEF remain inconclusive.