Commentary

Statins for A-fib are ready for prime time


 

The risk for atrial fibrillation increases with age and the presence of structural heart disease. AF exerts an enormous financial burden on the U.S. health care system. The overall prevalence of AF is 1%, and 70% of people with AF are 65 years of age or older. Inclusive of inpatient and outpatient expenditures, costs for the first episode of atrial fibrillation are estimated to be $15,000.

Perhaps we are all too familiar with the staggering resources consumed by patients who, despite adequate rate control, remain symptomatic. In these cases, an ounce of prevention could literally have been thousands of dollars of cure.

So, can we prevent A-fib?

Statins have been proposed as a way to do this. So, what’s the most recent evidence telling us about its efficacy?

Researchers in France conducted an updated systematic review of the literature to determine the benefit of statins for the prevention of AF (Curr. Opin. Cardiol. 2013;28:7-18). Studies were selected for inclusion if they were randomized, controlled clinical trials including a direct comparison between a statin and control condition or placebo.

Thirty-two studies were included, which enrolled a total of 71,005 patients. Statin use was significantly associated with a decreased risk of AF (odds ratio, 0.69; 95% CI: 0.57-0.83). The benefit of statin therapy was significant for the prevention of postoperative AF (OR, 0.37; 95% CI: 0.28-0.51) and secondary prevention of AF (OR, 0.57; 95% CI: 0.36-0.91). No clear benefit of statins for new-onset AF was identified, and no difference was observed between intensive and standard therapy.

The mechanism of action is hypothesized to be exerted through the anti-inflammatory and antioxidant effects of statins.

Some of these patients may already be on statins. But for those who are not and could tolerate them, the use of statins decreased the odds of postoperative and secondary AF by 40%-60%. This could result in enormous potential cost savings to the U.S. health care system.

The evidence is strong, so we need to ask ourselves, why are we not doing this already?

Dr. Ebbert is professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He reported having no relevant financial conflicts. The opinions expressed are those of the author.

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