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CLINICAL RESEARCH: PROTEAN EFFECTS OF STATINS

Are lipid-lowering drugs also antiarrhythmic drugs?

an analysis of the antiarrhythmics versus implantable defibrillators (AVID) trial

L. Brent Mitchell, MD, FACC^*,*, Judy L. Powell, BSN, Anne M. Gillis, MD, FACC^*, Victoria Kehl, PhC, Alfred P. Hallstrom, PhD the AVID Investigators

^* Foothills Hospital/University of Calgary, Calgary, Alberta, Canada
AVID Clinical Trial Center/University of Washington, Seattle, Washington, USA
Institut fuer Medizinische Statistik, Munich, Germany

Manuscript received February 15, 2002; revised manuscript received November 24, 2002, accepted December 26, 2002.

^* Reprint requests and correspondence: Dr. L. Brent Mitchell, Division of Cardiology, Foothills Hospital, 1403-29th Street NW, Calgary, Alberta, Canada, T2N 2T9.
brent.mitchell{at}calgaryhealthregion.ca

OBJECTIVES: This study sought to evaluate the antiarrhythmic effects of lipid-lowering drug therapy as assessed by ventricular tachyarrhythmia (ventricular tachycardia [VT]/ventricular fibrillation [VF]) recurrences recorded by an implantable cardioverter defibrillator (ICD) in patients with atherosclerotic heart disease (ASHD).

BACKGROUND: Randomized trials of lipid-lowering drugs suggest reduction of sudden death (SD) in patients with ASHD. Because SD is usually secondary to VT/VF, this observation suggests that lipid-lowering therapy has antiarrhythmic effects.

METHODS: The probability of VT/VF recurrence in patients with ASHD treated with an ICD in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial who did not receive lipid-lowering drug therapy (n = 279) was compared with that in patients who received early and consistent lipid-lowering therapy (n = 83). In addition, all-cause mortality and cardiac mortality of all patients in the AVID trial with ASHD who did not receive lipid-lowering therapy (n = 564) were compared with that of those who received early and consistent lipid-lowering therapy (n = 149).

RESULTS: Using multivariate analyses, lipid-lowering therapy was associated with a reduction in the relative hazard for VT/VF recurrence of 0.40 (95% confidence interval [CI] 0.15 to 0.58) (adjusted p = 0.003) in the ICD subgroup. Lipid-lowering therapy was also associated with a reduction in the relative hazard for all-cause mortality of 0.36 (95% CI 0.15 to 0.68) (adjusted p = 0.03) and a reduction in the relative hazard for cardiac mortality of 0.39 (95% CI 0.16 to 0.78) (adjusted p = 0.04) in the larger study population.

CONCLUSIONS: In patients with ASHD who have received an ICD, lipid-lowering therapy is associated with reduction in the probability of VT/VF recurrence, suggesting that part of the benefit of lipid-lowering therapy may be due to an antiarrhythmic effect.

Abbreviations and Acronyms   ASHD   atherosclerotic heart disease   AVID   Antiarrhythmics Versus Implantable Defibrillator trial   CI   confidence interval   HMG-CoA   3-hydroxy-3-methylglutaryl coenzyme A   ICD   implantable cardioverter defibrillator   SD   sudden death   VF   ventricular fibrillation   VT   ventricular tachycardia

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