title: Use of statins and antihypertensive medications in relation to risk of long-standing persistent atrial fibrillation.
abstract: BACKGROUND
  After an initial episode of atrial fibrillation (AF), patients may develop long-standing persistent or permanent AF.
  
  
  OBJECTIVE
  We evaluated whether use of statins, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or β-blockers is associated with lower risk of long-standing persistent AF after an initial AF episode.
  
  
  METHODS
  We conducted a population-based inception cohort study of participants enrolled in Group Health, aged 30 to 84 years, with newly diagnosed AF in 2001-2004. We included only participants whose initial AF episode terminated within 6 months of onset. We ascertained the primary outcome of long-standing persistent AF from medical records, electrocardiograms, and administrative data. We determined time-varying medication use from Group Health pharmacy data.
  
  
  RESULTS
  Among 1317 participants with incident AF, 304 developed long-standing persistent AF. Our study suggests that current statin use versus never use may be associated with lower risk for long-standing persistent AF. However, the association was not statistically significant when adjusted for age, sex, cardiovascular risk factors, and current use of antiarrhythmic medication (hazard ratio [HR] = 0.77; 95% CI = 0.57, 1.03). In lagged analyses intended to reduce healthy user bias, current statin use 1 year prior versus never use 1 year prior was not associated with risk for long-standing persistent AF (HR = 0.91; 95% CI = 0.67, 1.24). ACE inhibitor, ARB, and β-blocker use were not associated with risk for long-standing persistent AF.
  
  
  CONCLUSIONS
  Current statin use may confer protection that wanes after discontinuing use. Alternatively, healthy user bias or chance may explain the association. The association of statin use with long-standing persistent AF warrants further investigation.
authors: University of Washington, Seattle, WA, USA Brigham Young University, Provo, UT, USA elt@byu.edu.
authors: Evan L
authors: EL
authors: Thacker
authors: University of Washington, Seattle, WA, USA.
authors: Paul N
authors: PN
authors: Jensen
authors: University of Washington, Seattle, WA, USA Group Health Research Institute, Seattle, WA, USA.
authors: Bruce M
authors: BM
authors: Psaty
authors: University of Washington, Seattle, WA, USA.
authors: Barbara
authors: B
authors: McKnight
authors: University of Washington, Seattle, WA, USA.
authors: W T
authors: WT
authors: Longstreth
authors: University of Washington, Seattle, WA, USA Group Health Research Institute, Seattle, WA, USA.
authors: Sascha
authors: S
authors: Dublin
authors: University of Washington, Seattle, WA, USA Group Health Research Institute, Seattle, WA, USA.
authors: Katherine M
authors: KM
authors: Newton
authors: University of Washington, Seattle, WA, USA Group Health Research Institute, Seattle, WA, USA Veterans Affairs Office of Research and Development, Seattle, WA, USA.
authors: Nicholas L
authors: NL
authors: Smith
authors: University of Washington, Seattle, WA, USA New York Academy of Medicine, New York, NY, USA.
authors: David S
authors: DS
authors: Siscovick
authors: University of Washington, Seattle, WA, USA Group Health Research Institute, Seattle, WA, USA.
authors: Susan R
authors: SR
authors: Heckbert
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: antihypertensive agents; cohort studies; electrocardiography; hydroxymethylglutaryl-CoA reductase inhibitors; long-standing persistent atrial fibrillation; statins
references: Am Heart J. 2012 May;163(5):887-93
references: 22607868
references: Europace. 2012 Apr;14(4):528-606
references: 22389422
references: Curr Opin Cardiol. 2013 Jan;28(1):7-18
references: 23160338
references: J Gen Intern Med. 2013 Feb;28(2):247-53
references: 22972153
references: Int J Cardiol. 2013 Aug 10;167(3):624-30
references: 22999824
references: Eur Heart J. 2013 Aug;34(31):2464-71
references: 23594592
references: Circulation. 2014 Dec 2;130(23):e199-267
references: 24682347
references: J Am Heart Assoc. 2014 Jun;3(3):e000916
references: 24786144
references: J Cardiovasc Pharmacol. 2013 Oct;62(4):405-15
references: 23921300
references: Bone Marrow Transplant. 2001 Nov;28(10):909-15
references: 11753543
references: Am J Cardiovasc Drugs. 2002;2(1):37-42
references: 14727997
references: J Am Coll Cardiol. 2004 Jan 21;43(2):241-7
references: 14736444
references: Biometrics. 1978 Dec;34(4):541-54
references: 373811
references: N Engl J Med. 2005 May 5;352(18):1861-72
references: 15872201
references: J Am Coll Cardiol. 2005 Jun 7;45(11):1832-9
references: 15936615
references: Arch Neurol. 2005 Jul;62(7):1047-51
references: 16009757
references: Eur Heart J. 2007 Feb;28(4):457-62
references: 17289748
references: Int J Cardiol. 2008 May 23;126(2):160-70
references: 18031847
references: QJM. 2008 Nov;101(11):845-61
references: 18725372
references: N Engl J Med. 2009 Apr 16;360(16):1606-17
references: 19369667
references: Am J Hypertens. 2009 May;22(5):538-44
references: 19265792
references: Ann Intern Med. 2009 May 5;150(9):604-12
references: 19414839
references: Ann Intern Med. 2010 Jan 19;152(2):78-84
references: 20083826
references: J Am Coll Cardiol. 2010 Feb 23;55(8):725-31
references: 20170808
references: J Clin Lipidol. 2011 Jan-Feb;5(1):18-29
references: 21262503
references: J Cardiovasc Pharmacol Ther. 2011 Jun;16(2):178-84
references: 21285399
references: JAMA. 2011 May 25;305(20):2080-7
references: 21610240
references: Chest. 2012 Feb;141(2):339-47
references: 21622553
references: Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):632-9
references: 22787011