title: Statin Treatment and Clinical Outcomes of Heart Failure Among Africans: An Inverse Probability Treatment Weighted Analysis.
abstract: BACKGROUND
  Randomized control trials of statins have not demonstrated significant benefits in outcomes of heart failure (HF). However, randomized control trials may not always be generalizable. The aim was to determine whether statin and statin type-lipophilic or -hydrophilic improve long-term outcomes in Africans with HF.
  
  
  RESULTS
  This was a retrospective longitudinal study of HF patients aged ≥18 years hospitalized at a tertiary healthcare center between January 1, 2009 and December 31, 2013 in Ghana. Patients were eligible if they were discharged from first admission for HF (index admission) and followed up to time of all-cause, cardiovascular, and HF mortality or end of study. Multivariable time-dependent Cox model and inverse-probability-of-treatment weighting of marginal structural model were used to estimate associations between statin treatment and outcomes. Adjusted hazard ratios were also estimated for lipophilic and hydrophilic statin compared with no statin use. The study included 1488 patients (mean age 60.3±14.2 years) with 9306 person-years of observation. Using the time-dependent Cox model, the 5-year adjusted hazard ratios with 95% CI for statin treatment on all-cause, cardiovascular, and HF mortality were 0.68 (0.55-0.83), 0.67 (0.54-0.82), and 0.63 (0.51-0.79), respectively. Use of inverse-probability-of-treatment weighting resulted in estimates of 0.79 (0.65-0.96), 0.77 (0.63-0.96), and 0.77 (0.61-0.95) for statin treatment on all-cause, cardiovascular, and HF mortality, respectively, compared with no statin use.
  
  
  CONCLUSIONS
  Among Africans with HF, statin treatment was associated with significant reduction in mortality.
authors.affiliation: School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia kwadwo.osei.bonsu@monash.edu kbonsu2880@gmail.com.|Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Kwadwo Osei
authors.initials: KO
authors.lastname: Bonsu
authors.affiliation: Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.|Department of Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Isaac Kofi
authors.initials: IK
authors.lastname: Owusu
authors.affiliation: Department of Pharmacy Practice, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Kwame Ohene
authors.initials: KO
authors.lastname: Buabeng
authors.affiliation: School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Reidpath
authors.affiliation: School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia.
authors.forename: Amudha
authors.initials: A
authors.lastname: Kadirvelu
mesh_terms: D000368:Aged; D000069059:Atorvastatin / Q000737:chemistry / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology; D044383:Black People; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005229:Fatty Acids, Monounsaturated / Q000737:chemistry / Q000627:therapeutic use; D000077340:Fluvastatin; D005869:Ghana / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000737:chemistry / Q000627:therapeutic use*; D006973:Hypertension / Q000453:epidemiology; D007211:Indoles / Q000737:chemistry / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D000068718:Rosuvastatin Calcium / Q000737:chemistry / Q000627:therapeutic use; D019821:Simvastatin / Q000737:chemistry / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin
keywords: Africans; inverse probability treatment weighting; outcome; race and ethnicity; statin therapy