Effect of statins on atrial fibrillation: collaborative meta-analysis of published and unpublished evidence from randomised controlled trials

Rahimi, Kazem; Emberson, Jonathan; McGale, Paul; Majoni, William; Merhi, A.; Asselbergs, Folkert W.; Krane, Vera; Macfarlane, P. W.

doi:10.1136/bmj.d1250

Cited by 127 publications

(95 citation statements)

References 73 publications

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“…199 Similarly, the rate of post-operative atrial fibrillation was halved by perioperative statin therapy in some small randomized trials, but not in larger trials that assessed this outcome systematically. 200 Use of statin therapy has also been associated in observational studies with lower rates of several other conditions (e.g. infections, [201][202][203] chronic obstructive lung disease, [204][205][206] and acute respiratory distress syndrome 207 ), but those claims have been reliably refuted by randomized trials of adequate size.…”

Section: Other Beneficial Effects That Have Been Attributed To Statinmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms SummaryThis review is intended to help clinicians, patients and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomized controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures ("major vascular events") by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per

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Section: Other Beneficial Effects That Have Been Attributed To Statinmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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“…A more recent meta-analysis of seven hypothesis-generating trials with 3609 patients and 15 hypothesis-testing trials with 68 504 patients showed a 30% reduction in relative risk of AF in the hypothesis-generating trials and no effect in the hypothesis-testing trials. There was no difference in the effects of statins on primary or secondary prevention of AF [45] . Patel et al [46] included 14 trials with 7402 patients in their meta-analysis and showed that statins decreased AF rates by 45%, new-onset AF by 32%, recurrent AF by 57%, recurrent AF after cardioversion by 42%, and postoperative AF by 58%.…”

Section: Meta-analysesmentioning

confidence: 85%

Atrial fibrillation and inflammation

Özaydın

2010

WJC

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Atrial fibrillation (AF) is the most common clinical arrhythmia. Recent investigations have suggested that inflammation might have a role in the pathophysiology of AF. In this review, the association between inflammation and AF, and the effects of several agents that have anti-inflammatory actions, such as statins, polyunsaturated fatty acids, corticosteroids and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been investigated.

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“…Pooled results from six studies, with more than 160,000 patients (four studies with new-onset AF and two with AF in baseline), revealed an overall risk reduction of 35% with statin therapy (95% CI: 0.55-0.77, p < 0.0001), with the benefit being more conspicuous for new-onset AF (RR = 0.59, 95% CI: 0.48-0.73, p = 0.096) than for secondary prevention of AF (RR = 0.70, 95% CI: 0.43-1.14, p = 0.085) (178). Finally a meta-analysis including all large-scale statin trials did not show a significant reduction in atrial fibrillation in the active treatment group (RR = 0.95, 95% CI: 0.88-1.03, p = 0.24), and seven longer-term trials of more intensive versus standard statin regimens also showed no evidence of a reduction in the risk of atrial fibrillation (RR = 1.00, 95% CI: 0.90-1.12, p = 0.99) (129). Taken together, these findings suggest that statin treatment is not effective in the primary prevention of AF; however, it should be noted that AF was either not recorded or not included among the outcomes of the largest statin trials and event information for these analyses was mostly based on routinely collected data on adverse events.…”

Section: Primary Prevention Of Afmentioning

confidence: 95%

Targeting Inflammation and Oxidative Stress in Atrial Fibrillation: Role of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibition with Statins

Pinho-Gomes

Reilly

Brandes

et al. 2014

Antioxidants & Redox Signaling

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Significance: Atrial fibrillation (AF) is a burgeoning health-care problem, and the currently available therapeutic armamentarium is barely efficient. Experimental and clinical evidence implicates inflammation and myocardial oxidative stress in the pathogenesis of AF. Recent Advances: Local and systemic inflammation has been found to both precede and follow the new onset of AF, and NOX2-dependent generation of reactive oxygen species in human right atrial samples has been independently associated with the occurrence of AF in the postoperative period in patients undergoing cardiac surgery. Anti-inflammatory and antioxidant agents can prevent atrial electrical remodeling in animal models of atrial tachypacing and the new onset of AF after cardiac surgery, suggesting a causal relationship between inflammation/oxidative stress and the atrial substrate that supports AF. Critical Issues: Statin therapy, by redressing the myocardial nitroso-redox balance and reducing inflammation, has emerged as a potentially effective strategy for the prevention of AF. Evidence indicates that statins prevent AF-induced electrical remodeling in animal models of atrial tachypacing and may reduce the new onset of AF after cardiac surgery. However, whether statins have antiarrhythmic properties in humans has yet to be conclusively demonstrated, as data from randomized controlled trials specifically addressing the relevance of statin therapy for the primary and secondary prevention of AF remain scanty. Future Directions: A better understanding of the mechanisms underpinning the putative antiarrhythmic effects of statins may afford tailoring AF treatment to specific clinical settings and patient's subgroups. Large-scale randomized clinical trials are needed to support the indication of statin therapy solely on the basis of AF prevention. Antioxid. Redox Signal. 20, 1268Signal. 20, -1285

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Effect of statins on atrial fibrillation: collaborative meta-analysis of published and unpublished evidence from randomised controlled trials

Cited by 127 publications

References 73 publications

Interpretation of the evidence for the efficacy and safety of statin therapy

Interpretation of the evidence for the efficacy and safety of statin therapy

Atrial fibrillation and inflammation

Targeting Inflammation and Oxidative Stress in Atrial Fibrillation: Role of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibition with Statins

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