CLINICAL RESEARCH: HEART RHYTHM DISORDER
Reduction in Ventricular Tachyarrhythmias With Statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II
Anant K. Vyas, MD, MPH*,*,
Hongsheng Guo, MD ,
Arthur J. Moss, MD*,
Brian Olshansky, MD ,
Scott A. McNitt, MS*,
W. Jackson Hall, PhD ,
Wojciech Zareba, MD, PhD*,
Jonathan S. Steinberg, MD||,
Avi Fischer, MD||,
Jeremy Ruskin, MD¶,
Mark L. Andrews, BBA* for the MADIT-II Research Group
* Heart Research Follow-up Program of the Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Rochester, New York
Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
Cardiac Electrophysiology Division, Park Nicollet Clinic, St. Louis Park, Minnesota
University of Iowa Hospitals, Iowa City, Iowa
|| Cardiology Division of the Department of Medicine, St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
¶ Cardiology Division of the Department of Medicine, Massachusetts General Hospital and Harvard University, Boston, Massachusetts.
Manuscript received May 13, 2005;
revised manuscript received September 4, 2005,
accepted September 26, 2005.
* Reprint requests and correspondence: Dr. Anant K. Vyas, Heart Research Follow-up Program, University of Rochester Medical Center, 601 Elmwood Avenue, Box 653, Rochester, New York 14642. (Email: anantvyas{at}hotmail.com).
OBJECTIVES: We evaluated whether statins have anti-arrhythmic effects by exploring the association of statin use with appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia/ventricular fibrillation (VT/VF) in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.
BACKGROUND: A few studies have suggested that lipid-lowering drugs may have anti-arrhythmic effects in patients with coronary artery disease.
METHODS: Patients receiving an ICD (n = 654; U.S. centers only) in the MADIT-II study were categorized by the percentage of days each patient received statins during follow-up (90% to 100%, n = 386; 11% to 89%, n = 116; and 0% to 10%, n = 152). The Kaplan-Meier method with significance testing by the log-rank statistic and time-dependent proportional hazards regression analysis were used to evaluate the effect of statin use on the probability of ICD therapy for the combined end point VT/VF or cardiac death and for the end point VT/VF.
RESULTS: The cumulative rate of ICD therapy for VT/VF or cardiac death, whichever occurred first, was significantly reduced in those with  90% statin usage compared to those with lower statin usage (p = 0.01). The time-dependent statin:no statin therapy hazard ratio was 0.65 (p < 0.01) for the end point of VT/VF or cardiac death and 0.72 (p = 0.046) for VT/VF after adjusting for relevant covariates.
CONCLUSIONS: Statin use in patients with an ICD was associated with a reduction in the risk of cardiac death or VT/VF, whichever occurred first, and was associated with a reduction in VT/VF episodes. These findings suggest that statins have anti-arrhythmic properties.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CI = confidence interval | | ICD = implantable cardioverter-defibrillator | | MADIT = Multicenter Automatic Defibrillator Implantation Trial | | SCD = sudden cardiac death | | VA = ventricular arrhythmias | | VF = ventricular fibrillation | | VT = ventricular tachycardia |
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