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A Systematic Review and Meta-Analysis of the Effects of Statin Therapy on Heart Transplantation
Hossein Mardani-Nafchi1, Seyed Mahmoud Reza Hashemi Rafsanjani2, Saeid Heidari-Soureshjani3
1Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Postoperative statin therapy after heart transplantation (HT) significantly reduces mortality and cardiac allograft vasculopathy (CAV). While overall rejection rates were not significantly different, randomized controlled trials indicated a reduction in rejection with statin use, suggesting improved HT patient prognosis.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Heart transplantation (HT) mortality is primarily driven by cardiac allograft vasculopathy (CAV) and rejection.
- Effective strategies to improve long-term outcomes in HT recipients are crucial.
Conclusions:
- Postoperative statin therapy in heart transplant recipients is linked to reduced mortality and CAV.
- While overall rejection rates were not significantly impacted, statins may decrease rejection in specific study designs (RCTs).
- Statin therapy holds potential for improving the long-term prognosis of heart transplant patients.
Background:
Most of the mortality after Heart Transplantation (HT) is attributed to severe cardiac allograft vasculopathy (CAV) and rejection.
Objectives:
This meta-analysis aimed to investigate the effects of postoperative statin therapy on outcomes (mortality, rejection, and CAV in HT patients).
Methods:
This systematic review and meta-analysis was performed on publications between 1980 and October 2023 in Web of Science, Scopus, PubMed, Cochrane, Science Direct, Google Scholar, and Embase databases. Heterogeneity was assessed using Chi-square, I2, and forest plots. Publication bias was evaluated using Begg's and Egger's tests. Analyses were performed in Stata 15 with significance at p < 0.05.
Results:
This meta-analysis included 17 studies comprising 4,627 participants and conducted between 1995 to 2021. Compared to non-users, the odds of mortality were lower among statin users (OR= 0.49, 95% CI: 0.32-0.75, p < 0.001). The odds of CAV were also reduced with statin use (OR= 0.71, 95% CI: 0.53-0.96, p = 0.027). The odds of rejection were not significantly different (OR= 0.69, 95% CI: 0.41-1.15, p = 0.152). However, rejection odds were lower with statins in RCTs (OR= 0.42, 95% CI: 0.21-0.82, p = 0.012) but not in case-control studies (OR= 0.87, 95% CI: 0.49-1.52, p = 0.615). No publication bias was observed with Begg's test, but Egger's test showed possible bias.
Conclusion:
This meta-analysis found postoperative statin use associated with lower mortality and CAV, but not overall rejection, though RCT subgroup analysis showed decreased rejection with statins. Statin therapy may improve prognosis in HT patients.
