TY - JOUR

T1 - Statins reduce new-onset atrial fibrillation in a first-time myocardial infarction population

T2 - a nationwide propensity score-matched study

AU - Bang, Casper N

AU - Gislason, Gunnar H

AU - Greve, Anders M

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Wachtell, Kristian

PY - 2014/3

Y1 - 2014/3

N2 - AIM: To evaluate the effect of statins on reducing new-onset atrial fibrillation (AF) in a large real-world post-myocardial infarction (MI) population. Subsequently, to test if different statin doses, various types and compliance affected the incidence of new-onset AF post MI.METHODS: All patients with first-time acute MI between 1997 and 2009 in Denmark and claimed prescriptions of statins after discharge were identified from the Danish nationwide administrative registers. Patients with a history of AF were excluded. Risk of new-onset AF according to statin use were analysed by multivariable time-dependent Cox regressions models adjusted for age, gender, year, concomitant medication, and comorbidity, and additionally in a propensity score-matched analysis.RESULTS: A total of 89,703 patients with average follow up of 5.0 ± 3.5 years were included in this study. In the 56,044 patients receiving statins, 5698 (10%) had new-onset AF vs. 5010 (15%) in the 33,659 patients serving as controls. The adjusted Cox regression analysis showed significant reduction in new-onset AF (HR 0.83, 95% CI 0.80-0.87, p < 0.001) in statin users. Adjustment for propensity score yielded nearly identical results (HR 0.82, 95% CI 0.78-0.85, p < 0.001). Furthermore, patients compliant to statin treatment had significant reduction in new-onset AF (HR 0.84, 95% CI 0.80-0.87, p < 0.001). Finally, simvastatin and atorvastatin were significantly more effective than pravastatin (both p < 0.01) in reducing new-onset AF.CONCLUSIONS: Statin therapy was significantly associated with less new-onset AF in a nationwide cohort of post-MI patients. Furthermore, statins showed a type-dependent effect in preventing new-onset AF. These results support the beneficial effect of statin therapy beyond lipid lowering in patients with MI and underline the importance of statin adherence and choice of statin type.

AB - AIM: To evaluate the effect of statins on reducing new-onset atrial fibrillation (AF) in a large real-world post-myocardial infarction (MI) population. Subsequently, to test if different statin doses, various types and compliance affected the incidence of new-onset AF post MI.METHODS: All patients with first-time acute MI between 1997 and 2009 in Denmark and claimed prescriptions of statins after discharge were identified from the Danish nationwide administrative registers. Patients with a history of AF were excluded. Risk of new-onset AF according to statin use were analysed by multivariable time-dependent Cox regressions models adjusted for age, gender, year, concomitant medication, and comorbidity, and additionally in a propensity score-matched analysis.RESULTS: A total of 89,703 patients with average follow up of 5.0 ± 3.5 years were included in this study. In the 56,044 patients receiving statins, 5698 (10%) had new-onset AF vs. 5010 (15%) in the 33,659 patients serving as controls. The adjusted Cox regression analysis showed significant reduction in new-onset AF (HR 0.83, 95% CI 0.80-0.87, p < 0.001) in statin users. Adjustment for propensity score yielded nearly identical results (HR 0.82, 95% CI 0.78-0.85, p < 0.001). Furthermore, patients compliant to statin treatment had significant reduction in new-onset AF (HR 0.84, 95% CI 0.80-0.87, p < 0.001). Finally, simvastatin and atorvastatin were significantly more effective than pravastatin (both p < 0.01) in reducing new-onset AF.CONCLUSIONS: Statin therapy was significantly associated with less new-onset AF in a nationwide cohort of post-MI patients. Furthermore, statins showed a type-dependent effect in preventing new-onset AF. These results support the beneficial effect of statin therapy beyond lipid lowering in patients with MI and underline the importance of statin adherence and choice of statin type.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Atrial Fibrillation

KW - Chi-Square Distribution

KW - Comorbidity

KW - Denmark

KW - Female

KW - Heptanoic Acids

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors

KW - Male

KW - Medication Adherence

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Polypharmacy

KW - Pravastatin

KW - Propensity Score

KW - Proportional Hazards Models

KW - Pyrroles

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - Sex Factors

KW - Simvastatin

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1177/2047487312462804

DO - 10.1177/2047487312462804

M3 - Journal article

C2 - 23012689

VL - 21

SP - 330

EP - 338

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 3

ER -