Use of Statins and Antihypertensive Medications in Relation to Risk of Long-standing Persistent Atrial Fibrillation

Abstract

Background After an initial episode of atrial fibrillation (AF), patients may develop longstanding persistent or permanent AF. Objective We evaluated whether use of statins, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or beta-blockers is associated with lower risk of longstanding persistent AF after an initial AF episode. Methods We conducted a population-based inception cohort study of participants enrolled in Group Health, aged 30–84 with newly-diagnosed AF in 2001–2004. We included only participants whose initial AF episode terminated within six months of onset. We ascertained the primary outcome of longstanding persistent AF from medical records, electrocardiograms, and administrative data. We determined time-varying medication use from Group Health pharmacy data. Results Among 1,317 participants with incident AF, 304 developed longstanding persistent AF. Our study suggests that current statin use vs. never use may be associated with lower risk for longstanding persistent AF. However, the association was not statistically significant when adjusted for age, sex, cardiovascular risk factors, and current use of antiarrhythmic medication (hazard ratio [HR] = 0.77; 95% confidence interval [CI]: 0.57, 1.03). In lagged analyses intended to reduce healthy user bias, current statin use one year prior vs. never use one year prior was not associated with risk for longstanding persistent AF (HR = 0.91; 95% CI: 0.67, 1.24). ACE inhibitor, ARB, and beta-blocker use were not associated with risk for longstanding persistent AF. Conclusions Current statin use may confer protection that wanes after discontinuing use. Alternatively, healthy user bias or chance may explain the association. The association of statin use with longstanding persistent AF warrants further investigation.

Fluvastatin therapy could not decrease progression of paroxysmal atrial fibrillation in non-valvular disease patients

“…Recent studies ( 3 , 16 ) suggested that persistent or permanent AF was associated with worse prognosis than PAF. However, this study showed that fluvastatin did not reduce AF progression.…”

Administrative billing codes accurately identified occurrence of electrical cardioversion and ablation/maze procedures in a prospective cohort study of atrial fibrillation patients

“…For example, in our research on AF prognosis in Group Health, we have used 3‐code combinations for both electrical cardioversion and ablation/maze procedures, due to their high PPV, to determine occurrence of these procedures during follow‐up of the cohort extending beyond the time period during which medical records were reviewed. This enabled us to extend the follow‐up time in prospective studies of AF progression in relation to clinical characteristics or medication use …”

“…However, in circumstances in which specificity, PPV, or NPV is prioritized, these codes may be sufficiently clinical characteristics or medication use. 6,7 We are aware of only 1 other study that assessed accuracy of algorithms for identifying AF ablation. 5 Singh et al tested accuracy of 4 different algorithms in detecting AF ablation.…”

“…All other participants provided written consent or verbal consent by telephone. Further details of the study design, setting, and participants have been previously published …”

Atrial Heterogeneous Autonomic Neural Remodeling in Rabbits with Experimental Atrial Fibrillation and the Effect of Intervention by Rosuvastatin

“…Whether atrial septum undergoes ANR during AF or whether the difference of neural remodeling occurs from various parts of the atrium remains unclear. The preventive and therapeutic functions of statins in arrhythmia gained considerable attention because of their important role in atrial arrhythmia, such as AF . However, the mechanism of the inhibitory effect of statins on AF remains unknown, which was speculated to be related to their anti‐inflammatory and antioxidant effects.…”