Statins and new-onset atrial fibrillation in a cohort of patients with hypertension. Analysis of electronic health records, 2006–2015

Abstract

Hypertension is the most prevalent risk factor for new-onset atrial fibrillation (AF). But few studies have addressed the effect of statins on the incidence of this arrhythmia in patients with hypertension. This study aimed to evaluate the effect of statins on new-onset of this arrhythmia in a hypertensive population, accounting for AF risk. Data from the Information System for the Development of Research in Primary Care was used to recruit a retrospective cohort of ≥55-year-old hypertensive individuals with no ischemic vascular disease, in 2006–2007, followed up through 2015. The effect of initiating statin treatment on new-onset atrial fibrillation was assessed with Cox proportional hazards models adjusted by the propensity score of receiving statin treatment, in the overall study population and stratified by AF risk. Of 100 276 included participants, 9814 initiated statin treatment. The AF incidence per 1000 person-years (95% confidence interval) was 12.5 (12.3–12.8). Statin use associated with a significant (9%) reduction in AF incidence. Differences in absolute AF incidence were higher in the highest AF risk subgroup, and the estimated number needed to treat to avoid one case was 720. The relative effect was poor, similar across groups, and non-significant, as was the association of statins with adverse effects. We found a limited protective effect of statins over new-onset AF in this hypertensive population with no ischemic vascular disease. If there is no further indication, hypertensive patients would not benefit from statin use solely for AF primary prevention.

A new risk score to assess atrial fibrillation risk in hypertensive patients (ESCARVAL-RISK Project

“…In 2482 hypertensive patients with a mean age of 51 years and no initial pharmacological treatment, Verdecchia et al 19 found an AF rate of 4.6 per 1000 person-years. In contrast, Alvez-Cabratosa et al 29 observed an incidence rate that is more consistent with ours, of 12.5 per 1000 person-years in hypertensive www.nature.com/scientificreports www.nature.com/scientificreports/ patients in Spain. With regard to incidence by age group and sex, our results are concordant with those published elsewhere 26,27 : incidence is higher in men than in women and increases with age.…”

Upstream therapeutic strategies of valsartan and fluvastatin on hypertensive patients with non‐permanent atrial fibrillation

“…A meta-analysis that compared studies with long versus short follow-up found no benefit of statins on AF in the trials with longer term follow-up. 40 Alves-Cabratosa et al 41…”

“…A meta‐analysis that compared studies with long versus short follow‐up found no benefit of statins on AF in the trials with longer term follow‐up . Alves‐Cabratosa et al evaluated the effect of statins on new‐onset of this arrhythmia in a hypertensive population, accounting for AF risk, and found that a limited protective effect of statins over new‐onset AF in this hypertensive population with no ischemic vascular disease, hypertensive patients would not benefit from statin use solely for AF primary prevention. J‐RHYTHM II study has found that there were no significant differences between an ARB (candesartan) and a CCB (amlodipine) in the development of persistent AF in the treatment of paroxysmal AF associated with hypertension.…”

Ischemic stroke in patients with atrial fibrillation – do we need to treat with statins?

“…In a retrospective 2006-2015 cohort of 100,276 hypertensive individuals aged ≥ 55 without ischemic vascular disease (of whom 9,814 initiated a statin), statin use conferred on a 9% reduction in AF incidence (0.91; 0.84-0.99) 31 . The absolute risk reduction increased with higher estimated risk; however, the relative risk of AF was similar and did not reach statistical significance across risk stratification.…”