Treatment of patients with atrial fibrillation (AF) with statins was found to be associated with reduced all-cause and cardiovascular (CV) mortality, according to a study published in Pharmacological Research.
In this systematic review and meta-analysis, the MEDLINE and Cochrane databases were searched through March 15, 2020 for studies in which the efficacy of statins was examined in patients with AF. The study’s primary outcome of interest was all-cause mortality. Secondary outcomes included CV mortality, coronary artery disease, composite endpoints, ischemic stroke, and any bleeding complication.
A total of 14 studies (N=100,287; mean age, 70.6 years; 43.3% women; 23.2% on statin therapy) were included: 8 prospective studies, 4 retrospective observational trials, and 2 post-hoc analyses of randomized clinical trials. The quality of those studies was assessed.
The pooled hazard ratio (HR) for all-cause mortality was 0.59 (95% CI, 0.54-0.65). In patients treated with statins, there was a 10% absolute risk reduction in all-cause mortality (95% CI, 9-10).
In statin users, the pooled HR for CV mortality was 0.75 (95% CI, 0.58-0.96), and the pooled HR for bleeding events was 0.60 (95% CI, 0.48-0.76). There were no other relevant associations between stain use and any other secondary outcomes.
Study limitations include a lack of randomized clinical trial data and lack of information regarding statin type or dose, which precluded more precise analysis.
“These data are suggestive of statin use to reduce adverse cardiovascular events in patients with AF, as part of a holistic or integrated care approach to AF care,” noted the authors. “Underuse of statins in the AF population may account for a significant proportion of preventable deaths. Randomized clinical trials in patients [with AF] are necessary, as well as clarity on AF-specific low-density lipoprotein] cholesterol targets.”
Pastori D, Baratta F, Di Rocco A, et al. Statin use and mortality in atrial fibrillation: a systematic review and meta-analysis of 100,287 patients. Pharmacol Res. January 2021. doi:10.1016/j.phrs.2021.105418