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FOCUS ISSUE: ATRIAL FIBRILLATION: CLINICAL RESEARCH: STATINS AND ATRIAL FIBRILLATION

Antiarrhythmic Effect of Statin Therapy and Atrial Fibrillation

A Meta-Analysis of Randomized Controlled Trials

Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France.

Manuscript received August 17, 2007; accepted September 19, 2007.

^_* Reprint requests and correspondence: Dr. Laurent Fauchier, Service de Cardiologie B et Laboratoire d’Electrophysiologie Cardiaque, Pole Cœur Thorax Vasculaire Hémostase, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France. (Email: lfau{at}med.univ-tours.fr).

Objectives: To improve the evaluation of the possible antiarrhythmic effect of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of atrial fibrillation (AF).

Background: The use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored.

Methods: A systematic review of controlled trials with statins was performed. Eligible studies had to have been randomized controlled parallel-design human trials with use of statins that collected data on incidence or recurrence of AF.

Results: Six studies with 3,557 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF undergoing electrical cardioversion (n = 2), and 3 investigated the use of statins in primary prevention of AF in patients undergoing cardiac surgery or after acute coronary syndrome. Incidence or recurrence of AF occurred in 386 patients. Overall, the use of statins was significantly associated with a decreased risk of AF compared with control (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18 to 0.85, p = 0.02). Benefit of statin therapy seemed more marked in secondary prevention of AF (OR 0.33, 95% CI 0.10 to 1.03, p = 0.06) than for new-onset or postoperative AF (OR 0.60, 95% CI 0.27 to 1.37, p = 0.23).

Conclusions: Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome.

Abbreviations and Acronyms   AF = atrial fibrillation   CI = confidence interval   CRP = C-reactive protein   LDL = low-density lipoprotein   OR = odds ratio

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