Statin Treatment and Clinical Outcomes of Heart Failure Among Africans: An Inverse Probability Treatment Weighted Analysis

Abstract

BackgroundRandomized 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.Methods and ResultsThis 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.ConclusionsAmong Africans with HF, statin treatment was associated with significant reduction in mortality.

Evaluation of Dyslipidaemia Using an Algorithm of Lipid Profile Measures among Newly Diagnosed Type II Diabetes Mellitus Patients: A Cross-Sectional Study at Dormaa Presbyterian Hospital, Ghana

“…Treatment and control of dyslipidemia in low income countries such as Ghana is expensive, and the cost for treatment required to reduce further complications, especially in high-risk persons, exceeds the resources available in such countries [78]. Lifestyle modification, which involves changes in diet and increased physical activity/exercise, is an indispensable approach which has therefore been adopted alongside the validated statin therapy in Ghana [79] to ensure effective channeling of the limited resources. Prevention of dyslipidaemia is the best approach in such low-resource settings to avoid subsequent occurrence of cardiovascular diseases (CVDs) and reduce mortality.…”

Prevalence and Predictors of Statin Treatment Among Patients With Chronic Heart Failure at a Tertiary-Care Center in Thailand

“…A study conducted in African patients with their first-time diagnoses of CHF during hospitalization reported that 37% of the cohort were prescribed statin after discharge. 17 The cause of CHF was determined as non-ischemic in most (90%) of the cohort, a possible reason for the lower prevalence of statin treatment in this study. Because the prevalence of statin treatment in CHF patients seems high, the significant issue would be whether the treatment with statins in most CHF patients as reported in these studies is judicious.…”

Lipid disorders among Black Africans non-users of lipid-lowering medication

“…To our knowledge, the adherence rate to lipidlowering pharmacological therapy has not been documented in black African countries. Recently, a retrospective longitudinal study among Ghanaian heart failure patients has shown that statin users had a higher survival rate than those non-users who underwent another therapeutic option, but therapy adherence was not within the study's scope (32).…”