Statins and polyunsaturated fatty acids for treatment of atrial fibrillation.
Atrial fibrillation (AF) affects 1.5-2.0% of the population in the developed world. Projected data from population-based studies in the US indicate that the number of adults with AF will swell by 2.5-3.0-fold by 2050. Despite advances in pharmacological and nonpharmacological therapies for rhythm or rate control in patients with AF, primary prevention with 'upstream' therapy and risk factor modification is likely to produce a far greater effect in the general population than specific interventions. Rapidly developing experimental work has provided new insights into AF pathophysiology that will lead to new mechanism-based therapies. Agents targeting inflammation, oxidative injury, atrial myocyte metabolism, extracellular matrix remodeling, and fibrosis, have theoretical advantages as novel therapeutic strategies. Angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, statins, and omega-3 polyunsaturated fatty acids have shown antiarrhythmic potential, over and above any effect related to the treatment of underlying heart disease. These agents could be exploited to prevent or delay atrial remodeling in patients with AF, even in the absence of routine indications for such therapy. This Review provides a contemporary evidence-based insight into the possible preventive and reverse remodeling roles of statins and polyunsaturated fatty acids in AF.
Savelieva
Irina
I
Division of Cardiac and Vascular Sciences, St George's University of London, London, UK.
Camm
John
J
D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D005109:Extracellular Matrix / Q000187:drug effects / Q000378:metabolism; D005231:Fatty Acids, Unsaturated / Q000494:pharmacology / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D007473:Ion Channels / Q000187:drug effects / Q000378:metabolism; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy; D032383:Myocytes, Cardiac / Q000187:drug effects / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism; D018384:Oxidative Stress / Q000187:drug effects; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D005231:Fatty Acids, Unsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007473:Ion Channels; D009569:Nitric Oxide