title: The incidence and risk factors for new onset atrial fibrillation in the PROSPER study.
abstract: OBJECTIVE
  Atrial fibrillation/flutter (AF) is the most common arrhythmia in older people. It associates with reduced exercise capacity, increased risk of stroke, and mortality. We aimed to determine retrospectively whether pravastatin reduces the incidence of AF and whether any electrocardiographic measures or clinical conditions might be risk factors for its development.
  
  
  RESULTS
  The PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) was a randomized, double-blind controlled trial that recruited 5804 individuals aged 70-82 years with a history of, or risk factors for, vascular disease. A total of 2891 were allocated to pravastatin and 2913 to placebo; mean follow-up was 3.2 years. Electrocardiograms (ECGs), which were recorded at baseline, annually thereafter, and at run-out, were processed by computer and reviewed manually. In all, 264 of 2912 (9.1%) of the placebo group and 283 of 2888 (9.8%) of the pravastatin-treated group developed AF [hazard ratio 1.08 (0.92,1.28), P= 0.35)]. Multivariate analysis showed that PR and QTc intervals, age, left ventricular hypertrophy, and ST-T abnormalities were related to development of AF after adjustment for many variables including alcohol consumption, which itself was univariately predictive of developing AF. Previous myocardial infarction on the ECG was not a risk factor. A history of vascular disease was strongly linked with developing AF but not diabetes and hypertension.
  
  
  CONCLUSIONS
  Pravastatin does not reduce the incidence of AF in older people at risk of vascular disease, at least in the short-medium term. Risk factors for AF include older age, prolongation of PR or QTc intervals, left ventricular hypertrophy, and ST-T abnormalities on the ECG.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.forename: Heather
authors.initials: H
authors.lastname: Murray
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Brendan
authors.initials: B
authors.lastname: Buckley
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: James
authors.initials: J
authors.lastname: Shepherd
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D015994:Incidence; D008297:Male; D017035:Pravastatin / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin