Antiarrhythmic Effect of Statin Therapy and Atrial Fibrillation

A Meta-Analysis of Randomized Controlled Trials

Laurent Fauchier, MD, PhD; Bertrand Pierre, MD; Axel de Labriolle, MD; Caroline Grimard, MD; Noura Zannad, MD; Dominique Babuty, MD, PhD

Disclosures

J Am Coll Cardiol. 2008;51(8) 

In This Article

Abstract and Introduction

Objectives: To improve the evaluation of the possible antiarrhythmic effect of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of atrial fibrillation (AF).
Background: The use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored.
Methods: A systematic review of controlled trials with statins was performed. Eligible studies had to have been randomized controlled parallel-design human trials with use of statins that collected data on incidence or recurrence of AF.
Results: Six studies with 3,557 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF undergoing electrical cardioversion (n = 2), and 3 investigated the use of statins in primary prevention of AF in patients undergoing cardiac surgery or after acute coronary syndrome. Incidence or recurrence of AF occurred in 386 patients. Overall, the use of statins was significantly associated with a decreased risk of AF compared with control (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18 to 0.85, p = 0.02). Benefit of statin therapy seemed more marked in secondary prevention of AF (OR 0.33, 95% CI 0.10 to 1.03, p = 0.06) than for new-onset or postoperative AF (OR 0.60, 95% CI 0.27 to 1.37, p = 0.23).
Conclusions: Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome.

The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are hypothesized to have a benefit against arrhythmias in addition to well-established secondary prevention benefits for atherosclerotic coronary artery disease, yet the data are inconsistent. The use of statins had been suggested to protect against atrial fibrillation (AF) in some clinical and experimental studies but remained inadequately explored. Specifically, observational studies provided evidence supporting a protective role of statins against AF. However, insufficient data are available at this time to allow recommendations for prevention of AF with statins.[1,2] To improve the evaluation of the possible benefit of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of AF.

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