Liu Tong, Li Lijian, Korantzopoulos Panagiotis, Liu Enzhao, Li Guangping
Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
Int J Cardiol. 2008 May 23;126(2):160-70. doi: 10.1016/j.ijcard.2007.07.137. Epub 2007 Nov 26.
Inflammation and oxidative stress have been associated with atrial fibrillation (AF). On the other hand, accumulating evidence suggests that statins may have antiarrhythmic effects due to pleiotropic properties. However, inconsistent results have been reported with respect to AF.
We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) and observational studies to examine the association between statin use and development of AF.
PubMed, Cochrane clinical trials database, and EMBASE were searched until November 2006. In addition, a manual search was performed using all review articles on this topic, reference lists of papers, and abstracts from conference reports. Of the 309 initially identified studies, 6 RCTs and 10 observational studies with 7041 patients were finally analyzed.
The analysis of RCTs showed no significant effect of statins on AF development (RR=0.76, 95% CI:0.55-1.05, P=0.09), and significant heterogeneity between individual studies (P=0.0008, I(2)=74.0%). Subgroup analysis revealed that differences in AF detection methodology may be the cause of heterogeneity. The analysis of observational studies demonstrated that statin use reduced the relative risk for AF by 23% (95% CI:0.70-0.85, Z=4.95, P<0.00001) without significant differences between the trials (P=0.08, I(2)=41.2%). This favorable effect was greatest in the post-operative patients (RR=0.61, 95% CI:0.49-0.76, Z=4.30, P<0.0001).
Our meta-analysis suggests that statins may be effective in AF prevention especially in the post-operative setting. However, there are insufficient data for the widespread use of statins solely for AF prevention. Larger RCTs with long-term follow-up in different clinical settings, and more sensitive methods of arrhythmia detection are needed to clarify the impact of statins on AF.
炎症和氧化应激与心房颤动（AF）有关。另一方面，越来越多的证据表明，他汀类药物可能因其多效性而具有抗心律失常作用。然而，关于AF的报道结果并不一致。
我们对随机临床试验（RCT）和观察性研究进行了系统评价和荟萃分析，以研究他汀类药物的使用与AF发生之间的关联。
检索了截至2006年11月的PubMed、Cochrane临床试验数据库和EMBASE。此外，还使用了关于该主题的所有综述文章、论文的参考文献列表以及会议报告的摘要进行手动检索。在最初确定的309项研究中，最终分析了6项RCT和10项观察性研究，共7041例患者。
RCT分析显示他汀类药物对AF发生无显著影响（RR = 0.76，95%CI：0.55 - 1.05，P = 0.09），且各研究之间存在显著异质性（P = 0.0008，I² = 74.0%）。亚组分析表明，AF检测方法的差异可能是异质性的原因。观察性研究分析表明，使用他汀类药物可使AF的相对风险降低23%（95%CI：0.70 - 0.85，Z = 4.95，P < 0.00001），各试验之间无显著差异（P = 0.08，I² = 41.2%）。这种有益效果在术后患者中最为明显（RR = 0.61，95%CI：0.49 - 0.76，Z = 4.30，P < 0.0001）。
我们的荟萃分析表明，他汀类药物可能对预防AF有效，尤其是在术后环境中。然而，仅有不足的数据支持他汀类药物仅用于预防AF的广泛使用。需要在不同临床环境中进行长期随访的更大规模RCT以及更敏感的心律失常检测方法，以阐明他汀类药物对AF的影响。
