Reduction in life-threatening ventricular tachyarrhythmias in statin-treated patients with nonischemic cardiomyopathy enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).
OBJECTIVE
This study hypothesized that time-dependent statin therapy will reduce the risk of life-threatening ventricular tachyarrhythmias among patients with nonischemic cardiomyopathy (NICM) enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).


BACKGROUND
Prior studies suggested that statin therapy exerts antiarrhythmic properties among patients with coronary artery disease. However, data regarding the effect of statins on arrhythmic risk among patients with NICM are limited.


METHODS
Multivariate Cox proportional hazards regression modeling was used to assess the effect of statin therapy, evaluated as a time-dependent covariate, on the risk of appropriate defibrillator therapy for fast ventricular tachycardia (VT) (defined as a rate faster than 180 beats/min)/ventricular fibrillation (VF) or death (primary endpoint) and appropriate defibrillator shocks (secondary endpoint) among 821 patients with NICM enrolled in the MADIT-CRT trial.


RESULTS
Statin users (n = 499) were older and had a higher prevalence of diabetes and hypertension yet were less frequently smokers. Multivariate analysis showed that time-dependent statin therapy was independently associated with a significant 77% reduction in the risk of fast VT/VF or death (p < 0.001) and with a significant 46% reduction in the risk of appropriate implantable cardioverter defibrillator shocks (p = 0.01). Consistent with these findings, the cumulative probability of fast VT/VF or death at 4 years of follow-up was significantly lower among patients who were treated with statins (11%) as compared with study patients who were not treated with statins (19%; p = 0.006 for the overall difference during follow-up).


CONCLUSIONS
Statin use was associated with a significant reduction in the risk of life-threatening ventricular tachyarrhythmias among patients with NICM.
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel. yonibuber@gmail.com
Jonathan
J
Buber
Ilan
I
Goldenberg
Arthur J
AJ
Moss
Paul J
PJ
Wang
Scott
S
McNitt
W Jackson
WJ
Hall
Michael
M
Eldar
Alon
A
Barsheshet
Michael
M
Shechter
D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000628:therapy*; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors