The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trialsReportar como inadecuado




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BMC Cardiovascular Disorders

, 14:99

Non-coronary artery cardiac disease

Abstract

BackgroundA number of clinical and experimental studies have investigated the effect of atorvastatin on atrial fibrillation AF, but the results are equivocal. This meta-analysis was performed to evaluate whether atorvastatin can reduce the risk of AF in different populations.

MethodsWe searched PubMed, EMBASE and the Cochrane Database for all published studies that examined the effect of atorvastatin therapy on AF up to April 2014. A random effects model was used when there was substantial heterogeneity and a fixed effects model when there was negligible heterogeneity.

ResultsEighteen published studies including 9952 patients with sinus rhythm were identified for inclusion in the analysis. Ten studies investigated primary prevention of AF by atorvastatin in patients without AF, seven studies investigated secondary prevention of atorvastatin in patients with AF, and one study investigated mixed populations of patients. Overall, atorvastatin was associated with a decreased risk of AF odds ratio OR 0.51, 95% confidence interval CI 0.36–0.70, P < 0.0001. However, subgroup analyses showed that in the primary prevention subgroup OR 0.55, 95% CI 0.38–0.81, P = 0.002, atorvastatin reduced the risk of new-onset AF in patients after coronary surgery OR 0.44, 95% CI 0.29–0.68, P = 0.0002, but had no beneficial effect in patients without coronary surgery OR 0.97, 95% CI 0.59–1.58, P = 0.89; in the secondary prevention subgroup, atorvastatin had no beneficial effect on AF recurrence in patients with electrical cardioversion EC OR 0.57, 95% CI 0.25–1.32, P = 0.19 or without EC OR 0.38, 95% CI 0.14–1.06, P = 0.06.

ConclusionsThis meta-analysis suggests that atorvastatin has an overall protective effect against AF. However, this preventive effect was not seen in all types of AF. Atorvastatin was significantly associated with a decreased risk of new-onset AF in patients after coronary surgery. Moreover, atorvastatin did not prove to exert a significant protective effect against the AF recurrences in both patients who had experienced sinus rhythm restoration by means of EC and those who had obtained cardioversion by means of drug therapy. Thus, further prospective studies are warranted.

KeywordsAtrial fibrillation Atorvastatin Meta-analysis AbbreviationsAFAtrial fibrillation

RCTsRandomized clinical trials

ECElectrical cardioversion

MIRACLMyocardial Ischemia Reduction with Aggressive Cholesterol Lowering study

ARMYDA-3Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery study

SToP AFStatin therapy for the prevention of atrial fibrillation trial

SPARCLStroke Prevention by Aggressive Reduction in Cholesterol Levels

NOXNicotinamide adenine dinucleotide phosphate oxidase

ROSReactive oxygen species

MPOMyeloperoxidase.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-14-99 contains supplementary material, which is available to authorized users.

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Autor: Qian Yang - Xiaoyong Qi - Yingxiao Li

Fuente: https://link.springer.com/article/10.1186/1471-2261-14-99







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