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Effect of Statins on Atrial Fibrillation: Collaborative Meta-Analysis of Published and Unpublished Evidence From Randomised Controlled Trials
Study Questions:
Do statins prevent atrial fibrillation (AF)?
Methods:
This was a meta-analysis of randomized clinical trials that examined the effects of statins on various endpoints. If data on AF were not published along with the trial results, these data were solicited from the investigators.
Results:
There were 13 short-term trials (<6 months of follow-up) that included 4,414 patients. In these trials, statins were associated with a 39% relative reduction in the odds of AF (12.5% in the statin group vs. 17.4% in the control group). There were 29 long-term trials (1-5.3 years of follow-up) that included 134,755 patients. Unpublished data on AF were obtained from investigators for 23 of the 29 studies. Statins did not significantly reduce the risk of AF in these trials, with the prevalence of AF being approximately 2.5% in the statin and control groups. When high-dose statins were compared to standard doses, there was no significant difference in the odds of AF.
Conclusions:
The authors concluded that statins may prevent AF over the short-term, but there is no evidence of an antiarrhythmic effect of statins in long-term studies.
Perspective:
It is possible that statins prolong the interval of sinus rhythm between episodes of AF. This could explain why the risk of AF was reduced by statins when the duration of follow-up was >6 months, but not when the follow-up was >1 year. The goal of antiarrhythmic therapy often is not to completely eradicate AF, but to maximize the intervals between episodes. Therefore, this meta-analysis does not rule out a clinically helpful effect of statins on AF.
Keywords: Cooperative Behavior, Prevalence, Follow-Up Studies, Goals
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