Statin Use and Postoperative Atrial Fibrillation After Major Noncardiac Surgery

Study Questions:

Do statins prevent atrial fibrillation (AF) after noncardiac surgery?

Methods:

The data in this study were obtained from a database of surgical procedures performed at 375 hospitals. A total of 370,447 patients (mean age 63 years) who underwent major noncardiac surgery were identified. Postoperative AF requiring treatment and postoperative statin usage were identified.

Results:

A statin was used postoperatively in 79,871 patients (21.6%). The prevalence of postoperative AF was significantly lower among patients who received a statin (2.6%) than among the patients who did not receive a statin (3.0%). After adjustment for age, comorbidities, type of surgery, and other potential confounding variables, statin use was independently associated with a significant 21% reduction in the odds of postoperative AF. Among patients treated with a beta-blocker, statin therapy reduced the odds of postoperative AF by 11%. Statin usage was not significantly associated with mortality, length of stay, or cost of hospitalization.

Conclusions:

The authors concluded that statin therapy reduces the risk of AF after noncardiac surgery.

Perspective:

Statins reduce the incidence of postoperative AF probably because of their anti-inflammatory effects and direct ion channel effects on pulmonary vein muscle sleeves. However, an important mechanism of postoperative AF is adrenergic hyperactivity, explaining why the effect of statins was attenuated and very modest among patients treated with a beta-blocker.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, EP Basic Science, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Incidence, Confounding Factors (Epidemiology), Ion Channels, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Pulmonary Veins, Comorbidity, Atrial Fibrillation, Postoperative Period


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