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J Am Coll Cardiol, 2000; 36:766-772
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDY

Lipid lowering drugs and recurrences of life-threatening ventricular arrhythmias in high-risk patients

Johan De Sutter, MD*, Rene Tavernier, MD, PhD*, Marc De Buyzere, PhD*, Luc Jordaens, MD, PhD* and Guy De Backer, MD, PhD, FACC{dagger}

* Departments of Department of Cardiology, the University Hospital Ghent, Ghent, Belgium
{dagger} Department of Public Health of the University Hospital Ghent, Ghent, Belgium

Manuscript received December 3, 1999; revised manuscript received February 3, 2000, accepted April 19, 2000.

Reprint requests and correspondence: Dr. Johan De Sutter, Department of Cardiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
johan.desutter{at}rug.ac.be

OBJECTIVES

To evaluate a possible effect of lipid lowering drugs on recurrences of ventricular arrhythmias (VA) after implantable cardioverter defibrillator (ICD) implantation.

BACKGROUND

In patients with coronary artery disease (CAD), lipid lowering drugs reduce total and sudden cardiac death. Because the mechanism is not completely understood, we studied whether these drugs have a favorable influence on the occurrence of life-threatening VA in patients with CAD and ICD implants.

METHODS

We conducted an observational study in 78 patients with CAD and life-threatening VA, treated with an ICD. After ICD implantation, 27 patients were on treatment with lipid lowering drugs (group I) and 51 were not (group II). Patients were studied for the following end points: recurrences of VA requiring ICD intervention, cardiac death and hospitalization.

RESULTS

After a mean follow-up of 490 ± 319 days, 35 patients (45%) had recurrences of VA requiring ICD intervention. In multivariate analysis, the use of lipid lowering drugs (chi-square 6.33, p = 0.012) and poorly tolerated sustained monomorphic ventricular tachycardia as initial presentation (chi-square 4.84, p = 0.028) remained as independent predictors of recurrences of VA. Patients in groups I and II had similar baseline clinical characteristics, but patients in group I had a lower incidence of recurrences of VA (6/27 or 22% vs. 29/51 or 57%, p = 0.004) and of the combined end points of cardiac death and hospitalization (4/27 or 15% vs. 23/51 or 45%, p = 0.015) compared with patients in group II.

CONCLUSIONS

This is the first observation that the use of lipid lowering drugs is associated with a reduction of recurrences of VA in patients with CAD and ICD implants. These data require confirmation in a prospective randomized trial.

Abbreviations and Acronyms
  ATP = antitachycardia pacing
  CABG = coronary artery bypass grafting
  CAD = coronary artery disease
  HDL = high-density lipoprotein
  ICD = implantable cardioverter defibrillator
  LDL = low-density lipoprotein
  MI = myocardial infarction
  PTCA = percutaneous transluminal coronary angioplasty
  VA = ventricular arrhythmia
  VF = ventricular fibrillation
  VT = ventricular tachycardia




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