The role of statin therapy in the prevention of atrial fibrillation: a meta‐analysis of randomized controlled trials

Abstract

CorrespondenceMiss Wen-tong Fang, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China. Tel.: +86 152 6186 4062 Fax: +86 025 8371 8836 E-mail: fwtfu@163.com ------------------------------------------ WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia, and AF is associated with relatively higher all-cause mortality in both men and women.• However, there are limited treatment options for AF.• Statins are hypothesized to have a benefit against arrhythmias in addition to well-established secondary prevention benefit for atherosclerotic coronary artery disease, yet the data are inconsistent WHAT THIS STUDY ADDS• Statin therapy was significantly associated with a decreased risk of incidence or recurrence of AF.• The benefit of statin therapy seemed more markedly in secondary prevention than primary prevention.• These results provided some evidence for the benefit of statins beyond their lipid-lowering activity AIMSThe use of statins has been suggested to protect against atrial fibrillation (AF) in some clinical observational and experimental studies but has remained inadequately explored. This study was designed to examine whether statins can reduce the risk of AF. METHODSMeta-analysis of randomized, controlled trials with use of statins on incidence or recurrence of AF was performed. RESULTSTwenty studies with 23 577 patients were included in the analysis. Seven studies investigated the use of statins in patients with AF, 11 studies investigated the primary prevention of statins in patients without AF, and two studies investigated mixed populations of patients. The incidence or recurrence of AF occurred in 1543 patients. Overall, statin therapy was significantly associated with a decreased risk of AF compared with control (odds ratio 0.49, 95% confidence interval 0.37-0.65; P < 0.00001). A beneficial effect was found in the atorvastatin subgroup and the simvastatin subgroup, but not in the pravastatin subgroup or the rosuvastatin subgroup. The benefit of statin therapy appeared to be more pronounced in secondary prevention (odds ratio 0.34, 95% confidence interval 0.18-0.64; P < 0.0008) than in primary prevention (odds ratio 0.54, 95% confidence interval 0.40-0.74; P < 0.0001). CONCLUSIONSStatin therapy was significantly associated with a decreased risk of incidence or recurrence of AF. Heterogeneity was explained by differences in statin types, patient populations and surgery types. The benefit of statin therapy seemed more pronounced in secondary than in primary prevention.

Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

“…In 2 meta-analyses of randomized controlled trials, a significant association was seen between statin use and reduced risk of AFib, with a particularly strong relationship between statin use and lowered risk of recurrent AFib. 10,11 In addition, statin use before cardiac surgery has been associated with a reduced risk of postoperative AFib. 24 The reduced risk of AFib associated with statin use may be most pronounced among patients with higher CHADS 2 and CHA 2 DS 2 VASc scores, 25 the population of patients with AFib who is at highest risk for ischemic stroke.…”

“…[6][7][8][9] If nonlipidlowering mechanisms are indeed at play, it is reasonable to hypothesize that all groups of patients with ischemic stroke might benefit from statin therapy for secondary stroke prevention. The finding that statin use may reduce burden of AFib 10,11 provides an another mechanism by which statin use might reduce recurrent stroke risk in the specific group of patients with AFib: reduced time spent in AFib could translate to reduced stroke risk directly or indirectly via preserved left atrial structure and function.…”

Association of Copayment with Likelihood and Level of Adherence in New Users of Statins: A Retrospective Cohort Study

“…2 The suite of possible cardiovascular benefits from statins continues to extend with an increasing body of evidence, demonstrating reduction in incidence and recurrence of atrial fibrillation for patients treated with statins. [3][4][5] However, suboptimal adherence has been demonstrated in follow-up studies of statin consumption. 6,7 This diminished adherence has been correlated extensively with worse cardiovascular outcomes.…”

Mechanisms of cardioembolic stroke revisited. Atrial cardiopathy

“…Use of MRA in patients with hypertension or heart failure has been demonstrated to reduce LA fibrosis and remodelling and to be successful in primary as well as in secondary prevention of AF [34,35]. Statins were proven to substantially reduce the risk of AF incidence or recurrence and were more beneficial in secondary than primary prevention of arrhythmia, based on a meta-analysis of 20 studies [36].…”