Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: A randomized controlled trial

Kourliouros, Antonios; Valencia, Oswaldo; Hosseini, Majid; Mayr, Manuel; Sarsam, Mazin A.I.; Camm, John; Jahangiri, Marjan

doi:10.1016/j.jtcvs.2010.06.006

Cited by 34 publications

(22 citation statements)

References 21 publications

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“…Atorvastatin 40 mg/day for 7 days before surgery had the largest effect in preventing PNAF, with an absolute risk reduction of PNAF compared with placebo of 22·0% ( P = 0·017) . No differences were found between doses of atorvastatin of 80 and 40 mg/day .…”

Section: Resultsmentioning

confidence: 89%

“…Fifteen cohort studies and six RCTs evaluated the effect of preoperative and postoperative statins on preventing PNAF. Of the 15 cohort studies, ten studies found that statins prevented PNAF .…”

Section: Resultsmentioning

confidence: 99%

“…Statins. Fifteen cohort studies [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and six RCTs [42][43][44][45][46][47] evaluated the effect of preoperative and postoperative statins on preventing PNAF. Of the 15 cohort studies, ten studies found that statins prevented PNAF [24,27,31,33,36].…”

Section: Anti-inflammatory Strategiesmentioning

confidence: 99%

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Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review

Jacob

Nathoe

Dieleman

et al. 2014

Eur J Clin Investigation

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Background Postoperative new-onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The pathogenesis of PNAF is multifactorial. The concept of the postoperative inflammatory response, as a potential underlying mechanism has been extensively studied. This review aims to provide a comprehensive summary of literature relevant to the association between the inflammatory response following cardiac surgery and PNAF.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

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Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review

Jacob

Nathoe

Dieleman

et al. 2014

Eur J Clin Investigation

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“…Trials with different doses of atorvastatin were limited and with significant heterogeneity in the study populations, so subgroup analysis according to different doses was not performed in our meta-analysis. A previous meta-analysis [32] even came to the conclusion that the preventive effect of atorvastatin on AF may be more significant at a lower dose (10–40 mg/day), while a recent study [33] on patients undergoing cardiac surgery suggested that the preventive effect of atorvastatin on postoperative AF was not dose-dependent.…”

Section: Discussionmentioning

confidence: 99%

The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials

Yang

2014

BMC Cardiovasc Disord

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BackgroundA number of clinical and experimental studies have investigated the effect of atorvastatin on atrial fibrillation (AF), but the results are equivocal. This meta-analysis was performed to evaluate whether atorvastatin can reduce the risk of AF in different populations.MethodsWe searched PubMed, EMBASE and the Cochrane Database for all published studies that examined the effect of atorvastatin therapy on AF up to April 2014. A random effects model was used when there was substantial heterogeneity and a fixed effects model when there was negligible heterogeneity.ResultsEighteen published studies including 9952 patients with sinus rhythm were identified for inclusion in the analysis. Ten studies investigated primary prevention of AF by atorvastatin in patients without AF, seven studies investigated secondary prevention of atorvastatin in patients with AF, and one study investigated mixed populations of patients. Overall, atorvastatin was associated with a decreased risk of AF (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.36–0.70, P < 0.0001). However, subgroup analyses showed that in the primary prevention subgroup (OR 0.55, 95% CI 0.38–0.81, P = 0.002), atorvastatin reduced the risk of new-onset AF in patients after coronary surgery (OR 0.44, 95% CI 0.29–0.68, P = 0.0002), but had no beneficial effect in patients without coronary surgery (OR 0.97, 95% CI 0.59–1.58, P = 0.89); in the secondary prevention subgroup, atorvastatin had no beneficial effect on AF recurrence in patients with electrical cardioversion (EC) (OR 0.57, 95% CI 0.25–1.32, P = 0.19) or without EC (OR 0.38, 95% CI 0.14–1.06, P = 0.06).ConclusionsThis meta-analysis suggests that atorvastatin has an overall protective effect against AF. However, this preventive effect was not seen in all types of AF. Atorvastatin was significantly associated with a decreased risk of new-onset AF in patients after coronary surgery. Moreover, atorvastatin did not prove to exert a significant protective effect against the AF recurrences in both patients who had experienced sinus rhythm restoration by means of EC and those who had obtained cardioversion by means of drug therapy. Thus, further prospective studies are warranted.

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“…The final search identified 32 trials 30 & , 31,32 && , [33][34][35] that fulfilled the inclusion criteria. We conducted text searches with the terms 'statin' and 'atrial fibrillation'.…”

Section: Methodsmentioning

confidence: 99%

Statin therapy and atrial fibrillation

Fauchier

Clémenty

Babuty

2013

Current Opinion in Cardiology

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Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: A randomized controlled trial

Abstract: High-dose atorvastatin for 7 days before cardiac surgery conferred a nonsignificant reduction in postoperative atrial fibrillation when compared with a low-dose regimen. A larger study would be necessary to confirm the beneficial effect of high-dose statins in this setting.

Cited by 34 publications

References 21 publications

Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review

Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review

The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials

Statin therapy and atrial fibrillation

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