Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Int J Cardiol. 2013 Sep 30;168(2):1131-6. doi: 10.1016/j.ijcard.2012.11.087. Epub 2012 Dec 2.
Statin has potential protective effects against atrial fibrillation. Clinically, there is a need to predict the atrial fibrillation protective effects in statin-treated patients. The purpose of this study was to investigate if cardiovascular co-morbidities or cumulative defined daily doses (cDDDs) of statin use could predict statin efficacy in atrial fibrillation prevention.
Patients aged ≥ 50 years were identified from the Taiwan National Health Insurance Research Database. Medical records of 171,885 patients were used in this study, and 40,001 (23.3%) of the patients received statin therapy (≥ 28 cDDDs). Risk of new-onset atrial fibrillation in statin users and non-users (<28 cDDDs) was estimated.
During the 9-year follow-up period, 6049 patients experienced new-onset atrial fibrillation. Overall, statin therapy reduced the risk of atrial fibrillation by 28% (adjusted hazard ratio [HR] 0.72; 95% CI 0.68 to 0.77). There was a dose-response relationship between statin use and the risk of atrial fibrillation. The adjusted HRs for atrial fibrillation were 1.04, 0.85, and 0.50 when cDDDs ranged from 28 to 90, 91 to 365, and more than 365, respectively. Subgroup analysis showed that statin use was more beneficial in patients with higher CHADS2 and CHA2DS2VASc scores than those with a score of 0 (P value for interaction<0.001). The therapy provided no obvious beneficial effect in those with a CHADS2 score of 0, a CHA2DS2VASc score of 0, or cDDDs less than 91.
Statin therapy reduces the risk of new-onset atrial fibrillation in a dose-dependent manner, and is beneficial in patients with cardiovascular co-morbidities.
他汀类药物对房颤有潜在的保护作用。临床上，需要预测他汀类药物治疗患者的房颤保护作用。本研究旨在探讨心血管合并症或他汀类药物累计定义日剂量（cDDD）是否可预测房颤预防中他汀类药物的疗效。
本研究从台湾全民健康保险研究数据库中确定了年龄≥50 岁的患者。本研究共使用了 171885 名患者的病历记录，其中 40001 名（23.3%）患者接受了他汀类药物治疗（≥28 cDDD）。评估了他汀类药物使用者和非使用者（<28 cDDD）中新发房颤的风险。
在 9 年的随访期间，有 6049 名患者发生了新发房颤。总体而言，他汀类药物治疗可降低房颤风险 28%（校正后的危险比[HR]0.72；95%置信区间[CI]0.68 至 0.77）。他汀类药物使用与房颤风险之间存在剂量反应关系。当 cDDD 范围在 28 至 90、91 至 365 和超过 365 时，房颤的校正 HR 分别为 1.04、0.85 和 0.50。亚组分析显示，与 CHADS2 评分为 0 的患者相比，CHADS2 和 CHA2DS2VASc 评分较高的患者使用他汀类药物更有益（交互 P 值<0.001）。在 CHADS2 评分为 0、CHA2DS2VASc 评分为 0 或 cDDD 小于 91 的患者中，该治疗并未显示出明显的有益效果。
他汀类药物治疗可降低新发房颤的风险，呈剂量依赖性，并且对心血管合并症患者有益。
