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

Abstract

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.

Effect of Atorvastatin on Serum Levels of Total Cholesterol and High-Sensitivity C-reactive Protein in High-Risk Patients with Atrial Fibrillation in Asia

“…38 It is known that atorvastatin is a highly effective statin medication, which is widely used in clinical treatments and is the most studied statin in relation to AF. 11 Furthermore, atorvastatin can ameliorate acute coronary syndrome by downregulating angiotensin receptors, decreasing endothelin synthesis, increasing nitric oxide bioavailability, attenuating inflammation, limiting reactive oxygen species production, and protecting against complementmediated injury. 39,40 It has been suggested that atorvastatin medications can be beneficial for protection against AF due to their anti-inflammatory and antioxidant properties.…”

“…39,40 It has been suggested that atorvastatin medications can be beneficial for protection against AF due to their anti-inflammatory and antioxidant properties. 11 It has been reported that atorvastatin can decrease blood lipid levels, especially cholesterol, and …”

“…11 Functionally, it has been proven that statin therapy reduces the risk of coronary and cerebrovascular events across a broad spectrum of patients, and more intensive treatment provides a substantial additional event reduction. 12 High-dose atorvastatin treatment has resulted in lower hs-CRP levels, less inflammatory infiltration and atrial fibrosis, and a decreased frequency of AF.…”

Perspectives on the modern management of non-valvular atrial fi brillation

“…There is some supportive data for the use of atorvastatin in the prevention of AF post cardiac surgery, but patients need to be on it beforehand. (12) …”

The Use of Mineralocorticoid Receptor Antagonists in the Pre Vention of Atrial Fibrillation

“…Поэтому сегодня внимание исследователей все чаще привлекают так называемые препараты upstreamтерапии, которые способны предотвращать возникновение ФП, влияя на ее субстрат. К таким препаратам относят ингибиторы АПФ, АРА-2, статины, омега-3 полиненасыщенные жирные кислоты и антагонисты МКР [17][18][19][20]. Их противоаритмическое действие обусловлено несколькими факторами: предотвращением структурного ремоделирования предсердий за счет подавления процессов фиброзирования, воспаления и оксидативного стресса, улучшением гемодинамики путем снижения артериального давления (АД) и напряжения стенок камер сердца, а также предупреждением развития или прогрессирования поражения коронарных артерий, что, как известно, является одним из важнейших факторов риска ФП [21].…”