Comparison of Atorvastatin and Simvastatin in Prevention of Atrial Fibrillation After Successful Cardioversion

Abstract

SummaryRecent data have shown that statins can help prevent atrial fibrillation (AF). We hypothesized that statins vary in their ability to prevent AF after successful electrical cardioversion (EC).Sixty-five patients (29 receiving atorvastatin and 36 receiving simvastatin) who had undergone successful EC for persistent AF were included in the study. They received statins at least one month before EC, and continued the treatment through 2 years of followup. The statins they received were selected independently by their attending physicians.In the follow-up period, AF reoccurred in 11 (38.0%) patients of the atorvastatin group and in 24 (66.7%) patients of the simvastatin group. Using a logistic regression model, the unadjusted odds ratio (OR) of having an AF recurrence for patients on atorvastatin versus those on simvastatin was 0.31 (95% CI 0.11-0.85, P = 0.02). After adjustment for other potentially confounding variables (age, sex, hypertension, diabetes, ischemic heart disease, echocardiographic characteristics, and therapy), treatment with atorvastatin retained its significance for maintaining sinus rhythm in a multivariate model (OR 0.20, CI 0.04 to 0.98, P < 0.05).Our study suggests that atorvastatin and simvastatin exert different effects on the AF recurrence rate after successful EC. Larger prospective randomized trials are needed to definitively evaluate the role of different statins in patients with AF, especially on AF recurrence after EC. (Int Heart J 2009; 50: 153-160)

Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin

“…43) In addition, Naji, et al reported that atorvastatin was superior to simvastatin for preventing recurrence of persistent AF after electrical cardioversion in their retrospective study. 45) Our results were similar to those of Naji, et al showing atorvastatin to be more effective in preventing recurrence of paroxysmal AF than pravastatin. These results suggest that different types of statin treatments exert different levels of efficacy in preventing recurrence of paroxysmal AF.…”

“…In contrast, few studies have examined the efficacy of statins in patients with paroxysmal 44) and persistent AF on a long-term basis (> 2 years). 41,45) Pravastatin, a hydrophilic statin, was considered to be effective for preventing recurrence of AF after electrical cardioversion in a retrospective study, whereas its efficacy was neglected in a randomized open-label multicenter study. 42) However, atorvastatin, a lipophilic statin, was demonstrated to be effective for preventing recurrence of paroxysmal and persistent AF in a prospective randomized study.…”

The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions

“…Six trials examined patients with coronary artery disease [18,19,[21][22][23][24][25], six trials examined effect of statins in patients undergoing electrical conversion [26][27][28][29][30][31], four trials were on patients with MI [32][33][34][35], and four trials were undertaken in patients with pacemaker or implantable cardioverter-defibrillator (ICD) [36][37][38][39]. Two trials analyzed primary prevention of AF [17,40], one trial was on patients with heart failure [20], one trial was on AF after cerebral infarction, [41] one trial investigated in elderly patients [32] and finally one trial examined patients with left ventricular hypertrophy [42].…”

“…As it might be expected there was no significant effect among these studies. It has been suggested that different statins exert different preventive effect on AF [26]. When analyzing the effect of statins individually, in RCTs, no beneficial effect was noticed.…”

Simvastatin-induced up-regulation of gap junctions composed of connexin 43 sensitize Leydig tumor cells to etoposide: An involvement of PKC pathway

“…Nevertheless, an increase of gap junctional conductance by some compounds or methods can protect heart from life-threatening arrhythmia (Greener et al, 2012). Non-antiarrhythmic drugs simvastatin, coming as a surprise, exhibit antiarrhythmic ability in human by some unclear mechanism (Naji et al, 2009;Van Gelder, 2007). Moreover, beyond to its classical cholesterol-lowering action, simvastatin exerts benificial effects on osteoporosis, inflammation and other diseases that connexins also play a part in (Uzzan et al, 2007;van der Meij et al, 2013).…”