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 |
|
This article has been cited by other articles:
|
|
|
|
 
H. Desai, W. S. Aronow, F. S. Tsai, C. Ahn, H. M. Lai, H. Amin, K. Gandhi, W. H. Frishman, M. Cohen, and C. Sorbera
Statins Reduce Appropriate Cardioverter-Defibrillator Shocks and Mortality in Patients With Heart Failure and Combined Cardiac Resynchronization and Implantable Cardioverter-Defibrillator Therapy
Journal of Cardiovascular Pharmacology and Therapeutics,
September 1, 2009;
14(3):
176 - 179.
[Abstract]
[PDF]
|
|
|
|
|
|
|
H. Almroth, N. Hoglund, K. Boman, A. Englund, S. Jensen, B. Kjellman, P. Tornvall, and M. Rosenqvist
Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study
Eur. Heart J.,
April 1, 2009;
30(7):
827 - 833.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Sanchez-Quinones, F. Marin, V. Roldan, and G.Y.H. Lip
The impact of statin use on atrial fibrillation
QJM,
November 1, 2008;
101(11):
845 - 861.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Nichol, E. Thomas, C. W. Callaway, J. Hedges, J. L. Powell, T. P. Aufderheide, T. Rea, R. Lowe, T. Brown, J. Dreyer, et al.
Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome
JAMA,
September 24, 2008;
300(12):
1423 - 1431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Blangy, N. Sadoul, B. Dousset, A. Radauceanu, R. Fay, E. Aliot, and F. Zannad
Serum BNP, hs-C-reactive protein, procollagen to assess the risk of ventricular tachycardia in ICD recipients after myocardial infarction
Europace,
September 1, 2007;
9(9):
724 - 729.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M.S. Kostapanos, E.N. Liberopoulos, J.A. Goudevenos, D.P. Mikhailidis, and M.S. Elisaf
Do statins have an antiarrhythmic activity?
Cardiovasc Res,
July 1, 2007;
75(1):
10 - 20.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G. Ray, C. M. Norris, J. A. Udell, R. T. Tsuyuki, F. A. McAlister, M. L. Knudtson, and W. A. Ghali
Lipid-Lowering Therapy and Outcomes in Heart Failure
Journal of Cardiovascular Pharmacology and Therapeutics,
March 1, 2007;
12(1):
27 - 35.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. J. Goldberger, H. Subacius, A. Schaechter, A. Howard, R. Berger, A. Shalaby, J. Levine, A. H. Kadish, and for the DEFINITE Investigators
Effects of Statin Therapy on Arrhythmic Events and Survival in Patients With Nonischemic Dilated Cardiomyopathy
J. Am. Coll. Cardiol.,
September 19, 2006;
48(6):
1228 - 1233.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
e247 - e346.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
746 - 837.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. K. Vyas, H. Guo, A. J. Moss, B. Olshansky, S. A. McNitt, W. J. Hall, W. Zareba, J. S. Steinberg, A. Fischer, J. Ruskin, et al.
Reduction in Ventricular Tachyarrhythmias With Statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
769 - 773.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Sola, M. Q.S. Mir, S. Lerakis, N. Tandon, and B. V. Khan
Atorvastatin Improves Left Ventricular Systolic Function and Serum Markers of Inflammation in Nonischemic Heart Failure
J. Am. Coll. Cardiol.,
January 17, 2006;
47(2):
332 - 337.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Schwartz, S. K. Park, M. S. O'Neill, P. S. Vokonas, D. Sparrow, S. Weiss, and K. Kelsey
Glutathione-S-Transferase M1, Obesity, Statins, and Autonomic Effects of Particles: Gene-by-Drug-by-Environment Interaction
Am. J. Respir. Crit. Care Med.,
December 15, 2005;
172(12):
1529 - 1533.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Lorenz, C. Junger, K. Seidl, A. Gitt, S. Schneider, R. Schiele, H. Wienbergen, R. Winkler, M. Gottwik, W. Delius, et al.
Do statins influence the prognostic impact of non-sustained ventricular tachycardia after ST-elevation myocardial infarction?
Eur. Heart J.,
June 1, 2005;
26(11):
1078 - 1085.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. L. Lazar
Role of statin therapy in the coronary bypass patient
Ann. Thorac. Surg.,
August 1, 2004;
78(2):
730 - 740.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. P. Zipes
The year in electrophysiology
J. Am. Coll. Cardiol.,
April 7, 2004;
43(7):
1306 - 1314.
[Full Text]
[PDF]
|
|
|
|
