title: Statin use and risks of death or fatal rejection in the Heart Transplant Lipid Registry.
abstract: Although small, randomized trials have shown that statin use is associated with decreased risks of mortality and severe rejection, no study has examined statin therapy as used in actual practice in large numbers of heart transplant recipients. We analyzed data from the Heart Transplant Lipid Registry (n = 12 centers). Patients were included if they underwent transplantation between 1995 and 1999, survived >/=30 days after transplantation, and had >/=30 days of Registry follow-up. Multivariable Cox regression models, with propensity scoring performed to adjust for nonrandom allocation of statin therapy, were performed to determine the association of statin therapy with death and fatal rejection. The study included 1,186 patients, with a mean follow-up of 580 +/- 469 days; 937 patients (79%) received statin therapy. Overall, 71 patients (6%) died and 40 (3.4%) had fatal rejection. The statin group had a lower frequency of death (4% vs 13.7%, p <0.0001) and fatal rejection (2.4% vs 7.2%, p = 0.0001). Using multivariable Cox regression, with propensity scoring included to adjust for likelihood of receiving statin therapy, statin use was the only factor associated with lower risk of death (hazard ratio 0.29, 95% confidence interval 0.13 to 0.67) and fatal rejection (hazard ratio 0.27, 95% confidence interval 0.09 to 0.78). This study represents the largest population of heart transplant recipients analyzed for the relation between statin therapy and clinical outcomes in actual practice. Statin therapy was significantly associated with lower risk of death and fatal rejection, benefits that were independent of lipid values.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Wu
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Beth C
authors.initials: BC
authors.lastname: Short
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.forename: Hector O
authors.initials: HO
authors.lastname: Ventura
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Eisen
authors.forename: Branislav
authors.initials: B
authors.lastname: Radovancevic
authors.forename: Barry K
authors.initials: BK
authors.lastname: Rayburn
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Lake
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Spencer H
authors.initials: SH
authors.lastname: Kubo
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Fishbein
authors.forename: Xue-Qiao
authors.initials: XQ
authors.lastname: Zhao
authors.forename: Kevin D
authors.initials: KD
authors.lastname: O'Brien
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors