Statins and the Reduction of Sudden Cardiac Death

Abstract

Sudden cardiac death is an important cause of cardiovascular mortality with the majority of cases occurring in low-risk groups. HMG-CoA reductase inhibitors (statins) have recently been shown to reduce the incidence of ventricular tachycardia (VT)/fibrillation (VF) and sudden cardiac death, and this has been attributed to their pleiotropic effects. However, it is unclear whether this occurs through an 'indirect' anti-ischemic or 'direct' antiarrhythmic effect. We systematically reviewed articles published on MEDLINE between January 1996 and December 2009 focusing on the reduction of VT/VF and sudden cardiac death by statins and the potential mechanisms. Studies reporting sudden cardiac death or VT/VF outcomes with statin use (n = 23) or the pathophysiology of sudden cardiac death reduction by statins (n = 19) were included. We found that statins have been shown to reduce VT/VF and sudden cardiac death only in subjects with underlying coronary artery disease or ischemic cardiomyopathy. No definite benefits were seen with statins in sudden cardiac death and VT/VF in patients with non-ischemic cardiomyopathy. There is insufficient evidence to point toward a benefit in populations at low risk for VT/VF. In conclusion, an anti-ischemic rather than a primary antiarrhythmic effect emerges as the likely mechanism of sudden cardiac death reduction with statins.

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?

“…A recent review from Beri et al (2010) has addressed this question by collecting and systematically evaluating data published over a 13-year period on the reduction of VT and VF events, as well as sudden cardiac death in patients suffering from various cardiovascular diseases and treated with statins. They concluded that the anti-arrhythmic/anti-fibrillatory effects of statins most probably result from an anti-ischaemic rather than a direct anti-arrhythmic effect, since a definitive reduction in sudden cardiac death occurred only in patients with ischaemic-type cardiovascular diseases, such as coronary artery disease or ischaemic cardiomyopathy (Beri et al, 2010). These anti-ischaemic effects of statins are supposed to mediate through nitric oxide and can indirectly influence the generation of arrhythmias (Beri et al, 2010).…”

“…They concluded that the anti-arrhythmic/anti-fibrillatory effects of statins most probably result from an anti-ischaemic rather than a direct anti-arrhythmic effect, since a definitive reduction in sudden cardiac death occurred only in patients with ischaemic-type cardiovascular diseases, such as coronary artery disease or ischaemic cardiomyopathy (Beri et al, 2010). These anti-ischaemic effects of statins are supposed to mediate through nitric oxide and can indirectly influence the generation of arrhythmias (Beri et al, 2010).…”

Contrast-Induced Nephropathy and the Vascular Patient

“…[8][9][10][11][12][13] In the past few years, several studies 14 The protective effect of statins on CIN was later verified by the same group in a larger trial (n ¼ 29 409 patients). 15 Preprocedural statin treatment was associated with a lower incidence of CIN (4.37% vs 5.93%, P < .0001) and nephropathy requiring dialysis (0.32% vs 0.49%, P ¼ .03) compared with statin nonuse.…”

The effect of acute simvastatin administration on the ischaemia and reperfusion-induced ventricular arrhythmias in anesthetized dogs

“…A recent review from Beri et al [105] has addressed this question by collecting and systematically evaluating data published over a 13-year period on the reduction of VT and VF events, as well as sudden cardiac death in patients suffering from various cardiovascular diseases and treated with statins. They concluded that the anti-arrhythmic/anti-fibrillatory effects of statins most probably result from an anti-ischaemic rather than a direct anti-arrhythmic effect, since a definitive reduction in sudden cardiac death occurred only in patients with ischaemic-type cardiovascular diseases, such as coronary artery disease or ischaemic cardiomyopathy [105].…”

“…These anti-ischaemic effects of statins are supposed to mediate through nitric oxide and can indirectly influence the generation of arrhythmias [105].…”