title: Lipid-lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction.
abstract: BACKGROUND
  Inflammation and oxidative stress have been implicated in the pathogenesis of atrial fibrillation (AF). Lipid-lowering drugs, particularly statins and fibrates, possess anti-inflammatory and antioxidant properties.
  
  
  OBJECTIVE
  The purpose of this study was to assess the impact of lipid-lowering drug use on AF prevalence in patients with reduced left ventricular ejection fraction (LVEF).
  
  
  METHODS
  Data were obtained from ADVANCENT(SM), a multicenter registry of patients with reduced LVEF (<or=40%). Demographic, clinical, and echocardiographic parameters were collected from interviews and medical records. Medications, including lipid-lowering drugs, were recorded.
  
  
  RESULTS
  Of the 25,268 patients, 71.3% had hyperlipidemia, and 66.8% were prescribed lipid-lowering drugs. AF prevalence was 25.1% in patients taking lipid-lowering drugs compared with 32.6% in untreated hyperlipidemic patients and 32.8% in patients without hyperlipidemia (P <.001 for both comparisons). In multivariable analysis, lipid-lowering drug use remained significantly associated with reduced odds of AF (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.64-0.74), and this effect was larger than that of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR 0.85, 95% CI 0.79-0.92) or beta-blockers (OR 0.95, 95% CI 0.88-1.02). The beneficial impact of lipid-lowering drugs on AF risk was independent of their effects on the lipid profile. In patients in whom data on specific lipid-lowering drugs were available, 92% of the patients undergoing lipid-lowering therapy received statins, and 98% received statins and/or fibrates.
  
  
  CONCLUSIONS
  Use of lipid-lowering drugs in patients with reduced LVEF is associated with a significant reduction in the prevalence of AF independent of the lipid profile and other known arrhythmia risk factors. This effect is larger than that of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or beta-blockers and may be the result of the antioxidant and anti-inflammatory effects of statins and fibrates.
authors.affiliation: Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia 30322, USA. ihanna2@aol.com
authors.forename: Ibrahim R
authors.initials: IR
authors.lastname: Hanna
authors.forename: Brent
authors.initials: B
authors.lastname: Heeke
authors.forename: Heather
authors.initials: H
authors.lastname: Bush
authors.forename: Lynne
authors.initials: L
authors.lastname: Brosius
authors.forename: Diane
authors.initials: D
authors.lastname: King-Hageman
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Dudley
authors.forename: John F
authors.initials: JF
authors.lastname: Beshai
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Langberg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D015995:Prevalence; D012042:Registries; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents