Reduction in Ventricular Tachyarrhythmias With Statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II

Abstract

Statin use in patients with an ICD was associated with a reduction in the risk of cardiac death or VT/VF, whichever occurred first, and was associated with a reduction in VT/VF episodes. These findings suggest that statins have anti-arrhythmic properties.

Sudden Cardiac Death in Heart Failure

“…Amiodarone is the only antiarrhythmic drug that may reduce the risk of SCD in patients after myocardial infarction and represents a viable alternative in patients who are not eligible for, refuse, or who do not have access to ICD therapy for the prevention of SCD. 56 Although a post hoc analysis from the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II) showed that, among patients treated with ICD, those with background statin therapy had a lower rate of ventricular arrhythmias, 57 2 prospective studies of statins in systolic HF showed no benefit in terms of preventing or reducing SCD compared with placebo. 58,59 In addition, although it was thought that fish oil containing omega-3 polyunsaturated fatty acids could reduce SCD in patients with ischemic HF by reducing the risk of recurrent acute coronary syndrome, this hypothesis was not confirmed in a large randomized trial.…”

The effect of acute simvastatin administration on the severity of arrhythmias resulting from ischaemia and reperfusion in the canine: Is there a role for nitric oxide?

“…Kv4.3; Su et al, 2012). Certainly, long-term statin treatment by modulating the lipid portions of the sarcolemma, which contain the ion channel regulatory proteins and signalling molecules (lipid rafts), influence the ion channel conduction and ion transport (Maguy et al, 2006;Vyas et al, 2006), but it is not known whether such a mechanism would also account for the acute administration of statins. Nevertheless, considering that polyunsaturated fatty acids, which alter the structure of the sarcolemmal phospholipids, were able to evoke immediate antiarrhythmic effect (Billman et al, 1994;Kang and Leaf, 2000;Leaf et al, 2003), we may speculate that statins perhaps also possess such acute modulator properties on the lipid portions of the membrane.…”

Statins as Anti‐Arrhythmics: A Systematic Review Part II: Effects on Risk of Ventricular Arrhythmias

“…14 However, statin therapy in several other studies has been associated with a reduced risk for SCD. 11,13,14 Further trials are necessary to determine the relative contribution of statin therapy to improvement in arrhythmic and non-arrhythmic mortality in the setting of ischemic and nonischemic cardiomyopathies.…”

“…Each study has shown a significant reduction in mortality associated with statin use. The second Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II 13 which enrolled patients with ischemic cardiomyopathy and left ventricular ejection fraction ≤ 30% demonstrated that statin use was associated with a 28% reduction in the risk of a first VA event(hazard ratio 0.72, 95% CI 0.52-0.99, p = 0.046). In this analysis, statin use was also associated with a significant reduction in SCD (p < 0.01) in those receiving statin therapy for ≥ 90% of the follow-up period compared with those receiving statin therapy for ≤ 10% of the follow-up period.…”