Hanna Ibrahim R, Heeke Brent, Bush Heather, Brosius Lynne, King-Hageman Diane, Dudley Samuel C, Beshai John F, Langberg Jonathan J
Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia 30322, USA.
Heart Rhythm. 2006 Aug;3(8):881-6. doi: 10.1016/j.hrthm.2006.05.010. Epub 2006 May 9.
Inflammation and oxidative stress have been implicated in the pathogenesis of atrial fibrillation (AF). Lipid-lowering drugs, particularly statins and fibrates, possess anti-inflammatory and antioxidant properties.
The purpose of this study was to assess the impact of lipid-lowering drug use on AF prevalence in patients with reduced left ventricular ejection fraction (LVEF).
Data were obtained from ADVANCENT(SM), a multicenter registry of patients with reduced LVEF (<or=40%). Demographic, clinical, and echocardiographic parameters were collected from interviews and medical records. Medications, including lipid-lowering drugs, were recorded.
Of the 25,268 patients, 71.3% had hyperlipidemia, and 66.8% were prescribed lipid-lowering drugs. AF prevalence was 25.1% in patients taking lipid-lowering drugs compared with 32.6% in untreated hyperlipidemic patients and 32.8% in patients without hyperlipidemia (P <.001 for both comparisons). In multivariable analysis, lipid-lowering drug use remained significantly associated with reduced odds of AF (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.64-0.74), and this effect was larger than that of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR 0.85, 95% CI 0.79-0.92) or beta-blockers (OR 0.95, 95% CI 0.88-1.02). The beneficial impact of lipid-lowering drugs on AF risk was independent of their effects on the lipid profile. In patients in whom data on specific lipid-lowering drugs were available, 92% of the patients undergoing lipid-lowering therapy received statins, and 98% received statins and/or fibrates.
Use of lipid-lowering drugs in patients with reduced LVEF is associated with a significant reduction in the prevalence of AF independent of the lipid profile and other known arrhythmia risk factors. This effect is larger than that of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or beta-blockers and may be the result of the antioxidant and anti-inflammatory effects of statins and fibrates.
炎症和氧化应激与心房颤动（AF）的发病机制有关。降脂药物，尤其是他汀类药物和贝特类药物，具有抗炎和抗氧化特性。
本研究旨在评估降脂药物的使用对左心室射血分数（LVEF）降低患者AF患病率的影响。
数据来自ADVANCENT(SM)，这是一个LVEF降低（≤40%）患者的多中心注册研究。通过访谈和病历收集人口统计学、临床和超声心动图参数。记录所用药物，包括降脂药物。
在25268例患者中，71.3%患有高脂血症，66.8%的患者使用了降脂药物。服用降脂药物的患者AF患病率为25.1%，未治疗的高脂血症患者为32.6%，无高脂血症患者为32.8%（两组比较P均<.001）。在多变量分析中，使用降脂药物仍与AF发生几率降低显著相关（比值比[OR]0.69，95%置信区间[CI]0.64 - 0.74），且这种效应大于血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（OR 0.85，95%CI 0.79 - 0.92）或β受体阻滞剂（OR 0.95，95%CI 0.88 - 1.02）。降脂药物对AF风险的有益影响独立于其对血脂谱的作用。在可获得特定降脂药物数据的患者中，92%接受降脂治疗的患者使用了他汀类药物，98%使用了他汀类药物和/或贝特类药物。
LVEF降低患者使用降脂药物与AF患病率显著降低相关，这独立于血脂谱和其他已知的心律失常危险因素。这种效应大于血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或β受体阻滞剂，可能是他汀类药物和贝特类药物的抗氧化和抗炎作用的结果。
