Fauchier Laurent, Pierre Bertrand, de Labriolle Axel, Grimard Caroline, Zannad Noura, Babuty Dominique
Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France.
J Am Coll Cardiol. 2008 Feb 26;51(8):828-35. doi: 10.1016/j.jacc.2007.09.063.
To improve the evaluation of the possible antiarrhythmic effect of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of atrial fibrillation (AF).
The use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored.
A systematic review of controlled trials with statins was performed. Eligible studies had to have been randomized controlled parallel-design human trials with use of statins that collected data on incidence or recurrence of AF.
Six studies with 3,557 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF undergoing electrical cardioversion (n = 2), and 3 investigated the use of statins in primary prevention of AF in patients undergoing cardiac surgery or after acute coronary syndrome. Incidence or recurrence of AF occurred in 386 patients. Overall, the use of statins was significantly associated with a decreased risk of AF compared with control (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18 to 0.85, p = 0.02). Benefit of statin therapy seemed more marked in secondary prevention of AF (OR 0.33, 95% CI 0.10 to 1.03, p = 0.06) than for new-onset or postoperative AF (OR 0.60, 95% CI 0.27 to 1.37, p = 0.23).
Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome.
为了更好地评估他汀类药物可能的抗心律失常作用,我们对他汀类药物用于心房颤动(AF)发生率或复发率这一终点的随机试验进行了荟萃分析。
在一些临床观察性和实验性研究中,曾提示使用他汀类药物可预防AF,但仍未得到充分研究。
对使用他汀类药物的对照试验进行了系统评价。符合条件的研究必须是使用他汀类药物的随机对照平行设计人体试验,并收集了AF发生率或复发率的数据。
分析纳入了6项研究,共3557例窦性心律患者。3项研究调查了他汀类药物在有阵发性AF病史(n = 1)或接受电复律的持续性AF患者(n = 2)中的应用,3项研究调查了他汀类药物在接受心脏手术或急性冠状动脉综合征后的患者中预防AF的一级预防作用。386例患者发生了AF发生率或复发。总体而言,与对照组相比,使用他汀类药物与AF风险降低显著相关(优势比[OR] 0.39,95%置信区间[CI] 0.18至0.85,p = 0.02)。他汀类药物治疗的益处似乎在AF二级预防中(OR 0.33,95% CI 0.10至1.03,p = 0.06)比新发或术后AF中(OR 0.60,95% CI 0.27至1.37,p = 0.23)更为明显。
在有既往AF病史、接受心脏手术或急性冠状动脉综合征后的窦性心律患者中,使用他汀类药物与AF发生率或复发风险降低显著相关。