Bang Casper N
Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
Dan Med J. 2013 Oct;60(10):B4731.
Atrial fibrillation (AF) is a common complication after myocardial infarction (MI) and new-onset AF has been demonstrated to be associated with adverse outcome and a large excess risk of death in both MI and aortic stenosis (AS) patients. Prevention of new-onset AF is therefore a potential therapeutic target in AS and MI patients. Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent AF. Accordingly, statins are recommended as a class IIa recommendation for prevention of new-onset AF after coronary artery bypass grafting (CABG). However, this preventive effect has not been investigated on new-onset AF in asymptomatic patients with AS or a large scale first-time MI patient sample and data in patients not undergoing invasive cardiac interventions are limited. This PhD thesis was conducted at the Heart Centre, Rigshospitalet, Denmark, with the aim to investigate the three aforementioned questions and to add to the existing evidence of AF prevention with statins. This was done using three different settings: 1) a randomized patients sample of 1,873 from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, 2) a register patient sample of 97,499 with first-time MI, and 3) all published studies until beginning of June 2011 examining statin treatment on new-onset and recurrent AF in patients not undergoing cardiac surgery. This thesis revealed that statins did not lower the incidence or the time to new-onset AF in patients with asymptomatic AS. However, statin treatment showed an independently preventive effect on new-onset AF, including type-dependent effect and a trend to dosage-dependent effect. In addition, this thesis showed that good compliance to statin treatment was important to prevent new-onset AF. Finally, the meta-analysis in this PhD thesis showed a preventive effect in the observational studies although this effect was absent in the randomized controlled trials. Based on this PhD thesis, although there might be an effect in MI patients, primary statin treatment to prevent new-onset AF cannot be recommended in AS patients or in patients not undergoing cardiac surgery.
心房颤动（AF）是心肌梗死（MI）后常见的并发症，新发AF已被证明与MI和主动脉瓣狭窄（AS）患者的不良预后及死亡风险大幅增加有关。因此，预防新发AF是AS和MI患者潜在的治疗靶点。降脂药物，尤其是他汀类药物，具有抗炎和抗氧化特性，可能预防AF。因此，他汀类药物被推荐作为冠状动脉旁路移植术（CABG）后预防新发AF的IIa类推荐。然而，尚未在无症状AS患者或大规模首次MI患者样本中研究这种预防新发AF的效果，且未接受侵入性心脏干预的患者的数据有限。本博士论文在丹麦里格霍斯医院心脏中心开展，旨在研究上述三个问题，并补充他汀类药物预防AF的现有证据。这通过三种不同的研究来完成：1）来自辛伐他汀与依折麦布治疗主动脉瓣狭窄（SEAS）研究的1873例随机患者样本；2）97499例首次MI的登记患者样本；3）截至2011年6月初所有已发表的研究，这些研究考察了他汀类药物对未接受心脏手术患者新发和复发AF的治疗效果。本论文表明，他汀类药物并未降低无症状AS患者新发AF的发生率或发生时间。然而，他汀类药物治疗对新发AF显示出独立的预防作用，包括类型依赖性效应和剂量依赖性趋势。此外，本论文表明，他汀类药物治疗的良好依从性对预防新发AF很重要。最后，本博士论文的荟萃分析显示，观察性研究中有预防作用，尽管随机对照试验中未发现这种作用。基于本博士论文，尽管MI患者可能有效果，但不建议对AS患者或未接受心脏手术的患者进行他汀类药物一级治疗以预防新发AF。
