title: Dose-related effect of statins on atrial fibrillation after cardiac surgery.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common heart rhythm abnormality after cardiac surgery. It increases morbidity and prolongs hospital stay. A role for statins in the prevention of AF has been suggested. We hypothesized that the incidence of postoperative AF due to statin therapy is dose-related.
  
  
  METHODS
  A retrospective study of 680 consecutive patients undergoing coronary bypass graft surgery and/or aortic valve replacement was done. Excluded were 57 patients (8.4%) with history of AF, permanent pacemakers, and those receiving antiarrhythmic medication. Preoperative statin treatment and occurrence of postoperative AF were examined using propensity score matching to adjust for differences in patient characteristics between the statin and no-statin groups.
  
  
  RESULTS
  The cohort comprised 623 patients. The statin group had a 27.1% incidence of postoperative AF vs 38.3% in the no-statin group (adjusted odds ratio [OR], 2.00; 95% confidence interval, 1.24 to 3.24; p = 0.004). Simvastatin (40 mg) and atorvastatin (40 mg) demonstrated the greatest effect on postoperative AF at 15.6% and 21.2%, respectively, vs no statins (respective adjusted ORs, 3.89 [p < 0.0001] and 2.76 [p = 0.012]). Intermediate-dose (20 mg) statins were also effective against AF, at 24.4% for simvastatin (adjusted OR, 2.32; p = 0.004) and 26.4% for atorvastatin (adjusted OR, 1.99, p = 0.047). Low-dose statins, simvastatin or atorvastatin (10 mg), did not influence postoperative AF.
  
  
  CONCLUSIONS
  Statin treatment may reduce the incidence of AF after cardiac surgery. Higher-dose statins have the greatest preventative effect, whereas low-dose statins do not influence postoperative AF.
authors.affiliation: Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom.
authors.forename: Antonios
authors.initials: A
authors.lastname: Kourliouros
authors.forename: Ayesha
authors.initials: A
authors.lastname: De Souza
authors.forename: Neil
authors.initials: N
authors.lastname: Roberts
authors.forename: Anna
authors.initials: A
authors.lastname: Marciniak
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Valencia
authors.forename: John
authors.initials: J
authors.lastname: Camm
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D000069059:Atorvastatin; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011758:Pyrroles / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin