Reduction in ventricular tachyarrhythmias with statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.
OBJECTIVE
We evaluated whether statins have anti-arrhythmic effects by exploring the association of statin use with appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia/ventricular fibrillation (VT/VF) in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.


BACKGROUND
A few studies have suggested that lipid-lowering drugs may have anti-arrhythmic effects in patients with coronary artery disease.


METHODS
Patients receiving an ICD (n = 654; U.S. centers only) in the MADIT-II study were categorized by the percentage of days each patient received statins during follow-up (90% to 100%, n = 386; 11% to 89%, n = 116; and 0% to 10%, n = 152). The Kaplan-Meier method with significance testing by the log-rank statistic and time-dependent proportional hazards regression analysis were used to evaluate the effect of statin use on the probability of ICD therapy for the combined end point VT/VF or cardiac death and for the end point VT/VF.


RESULTS
The cumulative rate of ICD therapy for VT/VF or cardiac death, whichever occurred first, was significantly reduced in those with > or =90% statin usage compared to those with lower statin usage (p = 0.01). The time-dependent statin:no statin therapy hazard ratio was 0.65 (p < 0.01) for the end point of VT/VF or cardiac death and 0.72 (p = 0.046) for VT/VF after adjusting for relevant covariates.


CONCLUSIONS
Statin use in patients with an ICD was associated with a reduction in the risk of cardiac death or VT/VF, whichever occurred first, and was associated with a reduction in VT/VF episodes. These findings suggest that statins have anti-arrhythmic properties.
Heart Research Follow-up Program of the Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA. anantvyas@hotmail.com
Anant K
AK
Vyas
Hongsheng
H
Guo
Arthur J
AJ
Moss
Brian
B
Olshansky
Scott A
SA
McNitt
W Jackson
WJ
Hall
Wojciech
W
Zareba
Jonathan S
JS
Steinberg
Avi
A
Fischer
Jeremy
J
Ruskin
Mark L
ML
Andrews
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D017180:Tachycardia, Ventricular / Q000517:prevention & control / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000517:prevention & control / Q000628:therapy*
D000889:Anti-Arrhythmia Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors