Association between statin use and mortality in patients with implantable cardioverter-defibrillators and left ventricular systolic dysfunction.
BACKGROUND
A few previous nested cohort trials have evaluated the use of statins on survival and the occurrence of ventricular tachycardia or fibrillation (VT/VF). While the studies generally agreed on the survival effects, they disagreed on the magnitude of the mortality benefit and on the effect on VT/VF.


OBJECTIVE
The purpose of this study was to determine in a large, long-term follow-up cohort whether statin therapy could reduce mortality and the occurrence of VT/VF in a mixed population receiving an implantable cardioverter-defibrillator (ICD) for primary or secondary prevention and either ischemic or nonischemic cardiomyopathy.


METHODS
Cohort evaluation of all patients undergoing implantation of an ICD with a left ventricular ejection fraction <40% at an urban U.S. teaching hospital from December 1997 through January 2007. Multivariable analysis of predictors of mortality and VT/VF were conducted.


RESULTS
There were 314 deaths among the 1204 patients (26.1%). The use of statin therapy (n = 642) was associated with an adjusted hazard ratio of 0.67 (95% confidence interval [CI] 0.53-0.85; P<.001) for mortality as compared with the no-statin group (n = 562). The use of statin therapy was not associated with a reduction in the adjusted hazard ratio for VT/VF (0.85; 95% CI 0.68-1.06; P = .14).


CONCLUSIONS
Statin therapy is associated with a reduction in overall mortality in patients with ischemic or nonischemic cardiomyopathy with an ICD implanted for either primary or secondary prevention. The magnitude of survival benefit might have been underestimated given our inability to use statin as a time-dependent covariate.
Coleman
Craig I
CI
Division of Cardiology, Hartford Hospital, and University of Connecticut Schools of Pharmacy and Medicine, Storrs and Farmington, Connecticut 06102-5037, USA.
Kluger
Jeffrey
J
Bhavnani
Sanjeev
S
Clyne
Christopher
C
Yarlagadda
Ravi
R
Guertin
Danette
D
White
C Michael
CM
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000517:prevention & control*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality*; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors