Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Analysis of pravastatin to prevent recurrence of atrial fibrillation after electrical cardioversion. Atorvastatin prevents atrial fibrillation in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker: a prospective randomized trial. Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial. Effect of statin dose on incidence of atrial fibrillation: data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) and Aggrastat to Zocor (A to Z) trials. Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. High-dose atorvastatin and risk of atrial fibrillation in patients with prior stroke or transient ischemic attack: analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Prevention of atrial fibrillation and inflammatory response after on-pump coronary artery bypass using different statin dosages: a randomized, controlled trial Improved fibrinolysis after 1-year treatment with HMG CoA reductase inhibitors in patients with coronary heart disease. Design and rationale of the ARBITER trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol)--a randomized trial comparing the effects of atorvastatin and pravastatin on carotid artery intima-media thickness. Statins for Primary Prevention: The Debate Is Intense, but the Data Are Weak. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Postapproval Observational Studies of Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Atorvastatin Reduces the Incidence of Postoperative Atrial Fibrillation in Statin-Naive Patients Undergoing Isolated Heart Valve Surgery Statin for prevention of atrial fibrillation after off-pump coronary artery bypass grafting in Japanese patients.
Atrial  fibrillation ( AF ) is prevalent in the elderly , in patients with hypertension , and in patients with coronary artery disease ( CAD ) . We hypothesized that statin therapy might be effective in preventing AF in patients with CAD and examined this hypothesis in a sample of patients with chronic stable CAD without AF , followed prospect ively at a large outpatient cardiology practice . The association between statin use and the risk of developing AF was examined univariately and then with adjustment for potential confounding factors . Four hundred forty-nine men and women between the ages of 40 and 87 years were followed for an average of 5 years . Fifty-two patients ( 12 % ) developed AF during follow-up . Statin therapy was used by 59 % of the patients during the study period and was associated with a significantly reduced risk of developing AF ( crude odds ratio , 0.48 , 95 % confidence interval 0.28 to 0.83 ) . This association remained significant after adjustment for potential confounders , including age , hypertension , left ventricular systolic function , occurrence of heart failure or acute ischemic events , and baseline cholesterol and changes in cholesterol levels ( adjusted odds ratio 0.37 , 95 % confidence interval 0.18 to 0.76 ) . Use of  statins in patients with chronic stable CAD appears to be protective against AF . The underlying mechanism for this effect is unknown but appears to be independent of the reduction in serum cholesterol levels To test the hypothesis that a statin could reduce the recurrence rate of atrial fibrillation after electrical cardioversion ( EC ) , we performed an open , controlled multicenter study . Patients ( n = 114 ) who had atrial fibrillation > 48 hours and who were scheduled for EC were r and omized to receive 40 mg of pravastatin once daily for 3 weeks before and 6 weeks after EC or no drug in addition to st and ard therapy . Pravastatin did not reduce the recurrence rate of atrial fibrillation after EC BACKGROUND Increasing evidence suggests that atrial fibrillation ( AF ) is an inflammatory disease . Statins is an anti-inflammatory agent . The present study was conducted to test the efficacy of atorvastatin in preventing paroxysmal AF or atrial high rate episodes ( AHEs ) in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker . METHODS The effect of atorvastatin on time to the first attack of AF or AHE ( > or = 180 per minute and > or = 1 or 10 minutes ) , which was accurately detected by pacemaker interrogation , was evaluated in an open-label prospect i ve r and omized design for 1 year of follow-up . RESULTS Fifty-two patients ( 23 males , 70 + /- 13 years old ) were r and omized to the  statin group ( atorvastatin 20 mg/d ) and 54 ( 25 males , 72 + /- 13 years old ) to the  nonstatin group . Event-free survivals from AHE > or = 1 minute were not significantly different between the 2 groups ( log-rank P = .410 ) . However , patients in the nonstatin group were more likely to develop AHE > or = 10 minutes than those in the statin group ( log-rank P = .028 ) . Atrial high rate episode > or = 10 minutes occurred in 3 ( 5.8 % ) of 51 patients in the statin group after 1 year of follow-up , and 10 ( 19.2 % ) of 52 patients ( odds ratio 0.26 , P = .041 ) in the nonstatin group . The mean left atrial volume of the statin group was significantly lower than that of the nonstatin group at the end of follow-up ( 39.7 + /- 1.7 vs 43.7 + /- 1.9 mL , P < .0001 ) . CONCLUSIONS The present study demonstrated the efficacy of atorvastatin in preventing significant AF ( > or = 10 minutes ) and left atrial enlargement in patients with bradyarrhythmias and implantation of a pacemaker OBJECTIVE The preventative effect of statins on  postoperative atrial fibrillation  has been hypothesized . However , all studies to date have examined patients who did not receive statins  before their further allocation to treatment or no treatment . Because guidelines recommend the routine use of statins in patients with coronary artery disease , we set out to examine the effect of intensive statin pretreatment versus continuation of usual statin dose on atrial fibrillation after cardiac surgery . METHODS Patients receiving routine statin treatment and undergoing coronary artery bypass surgery or aortic valve replacement with no history of atrial fibrillation or antiarrhythmic medication were r and omized to receive atorvastatin 80 mg or atorvastatin 10 mg for 7 days before surgery in a single-blind fashion . The primary end point was the development of postoperative atrial fibrillation during hospital stay . RESULTS A total of 104 consecutive patients were included . Postoperative atrial fibrillation occurred in 33 patients ( 32.4 % ) . No significant differences were found in demographics , medical history , or intraoperative variables between treatment groups , with the exception of higher rate of β-blocker use in the atorvastatin 10 mg group ( 75 % vs 53 % , P = .002 ) and previous myocardial infa rct ion ( 62 % vs 42 % , P = .049 ) . The incidence of postoperative atrial fibrillation was lower in the atorvastatin 80 mg group when compared with the atorvastatin 10 mg group , but this difference did not reach statistical significance ( 29 % vs 36 % , P = .43 ) . CONCLUSIONS High-dose atorvastatin for 7 days before cardiac surgery conferred a nonsignificant reduction in postoperative atrial fibrillation when compared with a low-dose regimen . A larger study would be necessary to confirm the beneficial effect of high-dose statins in this setting BACKGROUND It is known that statins are effective in preventing atrial fibrillation ( AF ) in patients undergoing cardiac surgery . OBJECTIVE The purpose of this study was to evaluate the efficacy of statins in preventing AF recurrence following left atrial ablation . METHODS One hundred twenty-five patients who had no statin indication undergoing catheter ablation due to drug-refractory paroxysmal ( n = 90 ) or persistent ( n = 35 ) AF were r and omized in a prospect i ve , double-blind , placebo-controlled trial to receive 80 mg atorvastatin ( n = 62 ) or placebo ( n = 63 ) for 3 months . The primary endpoint was freedom from symptomatic AF at 3 months . Secondary endpoints included freedom from any atrial arrhythmia recurrence irrespective of symptoms , quality of life ( QoL ) , and reduction in C-reactive protein ( CRP ) . RESULTS At 3 months , 95 % of patients in the atorvastatin group were free of symptomatic AF compared with 93.5 % in the placebo group ( P = .75 ) . Similarly , 85 % of patients treated in the atorvastatin group remained free of any recurrent atrial arrhythmia vs 88 % of patients in the placebo group ( P = .37 ) . Mean CRP levels decreased in the atorvastatin group ( mean change -0.75 ± 3 , P = .02 ) and increased in the placebo group ( mean change 2.1 ± 19.9 , P = .48 ) . Mean QoL score improved significantly in both groups ( mean change 13.14 ± 18.2 in the atorvastatin group and 11.10 ± 17.7 in the placebo group , P = .53 ) . CONCLUSION In patients with no st and ard indication for statin therapy  , treatment with atorvastatin 80 mg/day following AF ablation does not decrease the risk of AF recurrence in the first 3 months and should not be routinely administered to prevent periprocedural arrhythmias BACKGROUND Inflammation has been suggested as a factor in the initiation and maintenance of  atrial fibrillation ( AF ) . Several observational studies have suggested that statins , presumably through their anti-inflammatory properties , decrease the risk of AF . METHODS We analyzed 2 large , r and omized trials , PROVE IT-TIMI 22 and phase Z of the A to Z trial , which compared lower- versus higher-intensity statin therapy to evaluate whether higher-intensity statin therapy lowered the risk of AF onset during the 2 years of follow-up . We hypothesized that higher-intensity statin therapy would decrease the risk of AF when compared to lower-intensity statin therapy . From each trial , patients experiencing the onset of AF during follow-up were identified from the adverse event reports . RESULTS Neither study showed a decreased AF risk with higher-dose statin . In PROVE IT-TIMI 22 , 2.9 % versus 3.3 % in the high- versus st and ard-dose statin therapy , respectively , experienced the onset of AF over 2 years ( OR 0.86 , 95 % CI 0.61 - 1.23 , P = .41 ) . In A to Z , rates were 1.6 % versus 0.99 % , respectively ( OR 1.58 , 95 % CI 0.92 - 2.70 , P = .096 ) . In both trials , C-reactive protein levels ( plasma or serum ) tended to be higher among patients experiencing the onset of AF . CONCLUSION Our r and omized comparison among 8659 patients found that higher-dose statin therapy did not reduce the short term incidence of AF among patients after acute coronary syndromes when compared with st and ard dose statin treatment OBJECTIVE Recent studies have suggested that statins reduce atrial fibrillation  after cardiothoracic surgery , but the use of proven prophylactic strategies such as beta-blockers and amiodarone in these studies was not provided . Therefore , we sought to determine whether preoperative statin use could reduce the incidence of  post-cardiothoracic surgery atrial fibrillation in a population who already had a high background use of beta-blockers and appreciable use of prophylactic amiodarone . METHODS Patients undergoing cardiothoracic surgery from the r and omized , controlled Atrial Fibrillation Suppression Trials I , II , and III were evaluated in this nested cohort evaluation . The patients ' demographics , surgical characteristics , medication use , and incidence of post-cardiothoracic surgery atrial fibrillation  ( atrial fibrillation > 5 minutes duration ) were uniformly and prospect ively collected as part of Atrial Fibrillation Suppression Trials I , II , and III . Multivariate logistic regression was used to calculate adjusted odds ratios with 95 % confidence intervals . RESULTS Overall , 331 patients ( 59.6 % ) received a statin preoperatively and 224 patients ( 40.4 % ) did not . The study population had an average age of 67.8 + /- 8.6 years , 77.1 % were male , 14.6 % had valve surgery , 6.1 % had a history of atrial fibrillation , 12.6 % had a history of heart failure , 84.0 % received postoperative beta-blockade , and 44.1 % received postoperative prophylactic amiodarone .  In total , 174 patients ( 31.4 % ) developed post-cardiothoracic surgery atrial fibrillation . Upon multivariate logistic regression , statin use was associated with a reduction in post-cardiothoracic surgery atrial fibrillation ( adjusted odds ratio : 0.60 ; 95 % confidence interval 0.37 - 0.99 ) . Higher intensity statin dosing ( equivalent of > or = 40 mg of atorvastatin ) seemed to be associated with the greatest reductions in post-cardiothoracic surgery atrial fibrillation ( adjusted odds ratio : 0.45 ; 95 % confidence interval 0.21 - 0.99 ) . CONCLUSIONS In a population with appreciable beta-blocker and amiodarone use , adjunctive preoperative statin use was still associated with a 40 % reduction in patients ' odds of developing post-cardiothoracic surgery atrial fibrillation BACKGROUND Observational analyses and short-term r and omized trials have suggested that statins reduce occurrence or recurrence of atrial fibrillation ( AF ) . We tested the hypothesis that long-term treatment with high-dose atorvastatin reduces occurrence of AF in patients with prior stroke or transient ischemic attack . METHODS We examined development of new AF in the SPARCL trial that compared atorvastatin 80 mg daily with placebo in 4,731 patients with prior stroke or transient ischemic attack . Patients who had chronic or paroxysmal AF or were taking medications for treatment or prophylaxis of AF at the time of enrollment were excluded .  Atrial fibrillation was identified from electrocardiograms su bmi tted to a blinded central electrocardiographic laboratory and from investigators ' adverse event reports . RESULTS Patients were followed up for a median of 4.8 years , corresponding to > 20,000 patient-years of observation with a median of 5 electrocardiograms per patient . The primary efficacy measure , the time from r and omization to first occurrence of new AF , did not differ between treatment groups . By intention to treat , there were 139 cases of new AF in the atorvastatin group and 122 cases in the placebo group , corresponding to incidence rates of 1.32 and 1.14 cases per 100 patient-years observation ( hazard ratio 1.15 , 95 % CI 0.90 - 1.46 , P = .26 ) . On-treatment analysis yielded similar findings , with incidence rates of 1.26 and 1.01 cases per 100 patient-years observation in the atorvastatin and placebo groups , respectively ( hazard ratio 1.25 , 95 % CI 0.94 - 1.67 , P = .12 ) . CONCLUSION High-dose atorvastatin does not prevent development of AF in patients with prior stroke or transient ischemic attack Abstract Background This r and omized controlled trial aim ed to evaluate the effects of seven-day preoperative treatment with two different dosages of atorvastatin on the incidence of postoperative atrial fibrillation ( POAF ) and release of inflammatory markers such as high-sensitive C-reactive protein ( hsCRP ) and interleukin-6 in patients undergoing elective first-time on-pump coronary artery bypass grafting ( CABG ) . Methods The cohort study comprised 212 consecutive patients , already taking statins , who underwent elective first-time CABG with cardiopulmonary bypass without history of atrial fibrillation ( AF ) . Patients were r and omly divided into two groups : those who received atorvastatin 40 mg ( TOR40 group , 111 patients ) and those who received 80 mg ( TOR80 group , 101 patients ) once a day for 7 days before the planned operation . The primary endpoint was the incidence of AF . The secondary endpoints were the postoperative variations of inflammatory markers , hospital length of stay , and the incidence of major adverse cardiac and clinical events . Results A total of 26 patients ( 23.6 % ) pretreated with atorvastatin 40 mg and 16 ( 15.8 % ) patients pretreated with atorvastatin 80 mg had postoperative AF but the difference did not reach the statistical significance ( p = 0.157 ) . Median values of interleukin-6 and hsCRP at 12 and 24 h did not have differences between the two groups . No statistically significant differences in the other secondary endpoints were detected . Conclusions According to our result , 7-day preoperative treatment with a high dose of atorvastatin is associated with a trend to a decrease in the incidence of POAF compared with treatment at a lower dose , although it does not impact on the level of inflammatory markers . Clinical Trial Registration European Clinical Trials Data base ( EudraCT : 2006 - 005757 - 30 ) The study was aim ed to investigate the effect of two different statins on the levels of haemostatic variables reflecting procoagulant and fibrinolytic activity in patients with coronary heart disease ( CHD ) , with the hypothesis that statins might beneficially modify these levels . Fifty-eight patients were r and omized to treatment with atorvastatin ( n=28 ) or simvastatin  ( n=30 ) for 1 year . The starting dose in both groups was 20 mg/day . Fasting blood sample s were collected before and after 12-month treatment for determinations of fibrinogen , prothrombin fragment 1 + 2 ( F1 + 2 ) , plasma D-dimer , soluble tissue factor , tissue plasminogen activator ( tPA ) antigen , tPA activity , plasminogen activator inhibitor type-1 activity ( PAI-1 activity ) and serum D-dimer as a global test of fibrinolytic activity . In the total population , improved fibrinolytic activity was observed after 1 year with increased levels of serum D-dimer ( P=.001 ) and tPA activity ( P=.024 ) and a reduction in tPA antigen ( P=.048 ) . No statistically significant changes were observed in any of the measured coagulation variables . Separately examined , an improved fibrinolytic profile was seen in the atorvastatin group with a significant increase in serum D-dimer ( P=.005 ) , a borderline increase in tPA activity ( P=.083 ) and a borderline reduction in tPA antigen ( P=.069 ) . Within the simvastatin group , a reduction in prothrombin F1 + 2 was observed ( P=.038 ) . The differences in changes between the groups were statistically significant only for global fibrinolysis ( serum D-dimer , P=.046 ) . In conclusion , an improved fibrinolytic profile was observed after statin treatment , most pronounced with atorvastatin . The results indicate that the drugs promote a profibrinolytic profile , and may in part explain the benefit of statin treatment rendered in the prevention of CHD BACKGROUND As a class , statins are remarkably effective in reducing low-density lipoprotein ( LDL ) cholesterol , and several of these drugs have now been shown to reduce coronary heart disease morbidity and mortality . However , several important controversies in the use of statins remain to be answered by clinical trials . For example , it is controversial whether marked cholesterol reduction to levels below 100 mg/dL would further reduce the incidence of coronary heart disease . Furthermore , concerns about differences among statins for nonlipid effects has raised the concern that the assumption of a class effect is premature until head-to-head clinical trials are completed . METHODS Arterial Biology for the Investigation for the Treatment Effects of Reducing Cholesterol ( ARBITER ) is a single-center , r and omized , active-controlled study comparing the efficacy of high-dose atorvastatin ( 80 mg/d ) and pravastatin ( 40 mg/d ) in patients being treated for either the primary or secondary prevention of coronary heart disease . This trial will enroll up to 200 patients for the primary end point of the mean change in intima-media thickness of the common carotid artery . This effect will be evaluated over a treatment duration of 12 months . Secondary end points include the effects of statin therapy on inflammatory and hemostatic markers ( C-reactive protein and fibrinogen ) . CONCLUSION ARBITER will provide important data on the role of marked LDL reduction and the " class effect " theory of statin therapy in cardiovascular medicine This issue of JAMA contains the latest US Preventive Services Task Force ( USPSTF ) recommendation statement on statins for prevention of cardiovascular disease in adults,1 along with the accompanying evidence report and systematic review 2 on which the recommendations are based . The evidence report summarized data from 19 trials including a total of 71 344 patients and concluded that statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and cardiovascular disease ( CVD ) events . Thus , the task force recommended “ initiating use of lowto moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 10 % or greater ( B recommendation ) ” or “ 7.5 % to 10 % ( C recommendation ) .”1 Although the task force did their usual careful job of review ing the evidence , the evidence for treating asymptomatic persons with statins does not appear to merit a grade B or even a grade C recommendation . The task force evidence report estimated an absolute benefit for use of statins of 0.40 % for all-cause mortality and 0.43 % for cardiovascular mortality and indicated that the absolute benefit was greater for patients at greater baseline risk.2 Notably , the evidence report did not exclude studies that included patients taking statins for secondary prevention , who have a higher baseline risk of cardiac events and death and thus are more likely to benefit from therapy that inflates the benefit attributed to a primary prevention population . The task force did perform a sensitivity analysis that excluded 3 trials with persons for whom there were prior “ hard ” cardiovascular events and obtained similar results of benefits ( eTable 5 in the article by Chou et al2 ) . This sensitivity analysis did not exclude WOSCOPS , which included patients receiving statins for secondary prevention—5 % had angina and 3 % had intermittent claudication,3 accounting for 15 % of the total weight in the meta- analysis . In contrast , a meta- analysis of 11 studies and 65 229 patients receiving statins for primary prevention , in which patients receiving statins for secondary prevention were excluded , found no benefit of statins for reducing all-cause mortality.4 The confidence intervals of these 2 analyses overlap , and the difference between these findings likely reflects differences in studies included . The USPSTF and authors of the evidence report did not have access to the primary data ( clinical study reports and anonymized patient-level data ) from the statin clinical trials . Rather , they had to rely on peer- review ed published reports as the basis for these recommendations . Exacerbating the potential bias , all of the trials included in the task force evidence report2 were industry-sponsored except 1 trial,5 and that trial contributed 0.2 % of the weight to the mortality calculation . Industry-sponsored studies have been shown to report greater benefit and lesser adverse effects than noncommercially sponsored trials of the same drugs.6 Whether this is true for statins and primary prevention of CVD is unknown . Among the 19 r and omized clinical trials of statins vs placebo or no statin included in the evidence report for the task force recommendations , only 15 reported all-cause mortality , 10 reported cardiovascular mortality , 12 reported fatal and nonfatal myocardial infa rct ion  , and 13 reported fatal and nonfatal stroke.2,7  Reliance on selective reporting of the most important outcomes , which are likely included in the clinical trial data , makes reporting bias possible . Furthermore , after allcause mortality , the comparative incidence of serious adverse events between treatment and control groups is arguably the second most important measure of the effect of active therapy in r and omized clinical trials . Underst and ing the evidence base in evaluating harms of statin therapy is also critically important . Although the benefits of any preventive therapy accrue according to risk of disease ( greater benefit in higher-risk patients ) , the harms of therapy usually distribute equally over all risk levels . Thus , persons at low risk have little chance of benefit but equal chance of harms and thus are more likely to have a net harm . The evidence base for harms of statins , despite the introduction of these drugs more than 20 years ago , is incomplete . Many of the trials did not ask about commonly reported statin effects , such as muscle pains and weakness , and only recorded myopathy , for which an increase in creatine kinase levels was required . Because most muscle problems do not involve an increase in creatine kinase levels , this leads to a significant underestimate of muscle problems . Other studies have estimated that closer to 20 % of statin users have muscle problems.8 Additionally , the actual trial data are largely held by the Cholesterol Treatment Trialists ’ Collaboration on behalf of the industry sponsor and have not been made available to other research ers , despite multiple requests over many years.9 Although reported rates of adverse events in clinical trials are low , this does not reflect the experience of clinicians who see patients who are taking statins . For instance , the experience of an NPR reporter with a calculated 2.9 % risk of heart disease over 10 years using the recommended American College of Cardiology/American Heart Association ( ACC/AHA ) risk calculator,10 but still prescribed a statin , and experiencing adverse effects from the medication , is typical of what many Related articles at jama.com Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients The pivotal r and omized clinical trials ( RCTs ) of non – vitamin K antagonist oral anticoagulants ( NOACs ) for stroke prevention in atrial fibrillation ( AF ) established the efficacy and safety of these drugs for patients with AF without mechanical prosthetic heart valves or significant ( rheumatic ) mitral valve stenosis.1 A clinical trial setting with strict inclusion and exclusion criteria was needed to obtain high- quality scientific evidence on the effects of NOACs compared with st and ard care ( ie , warfarin ) , but these results in highly selected trial cohorts may not be fully applicable to a diversity of patients or clinical circumstances encountered in daily practice OBJECTIVE It has been recently reported that AF is associated with tissue inflammation . Statins reduce C-reactive protein ( CRP ) levels . However , the effect of statin on atrial fibrillation ( AF ) is unclear . The purpose of the present study was to evaluate the effect of statin on AF in a canine sterile pericarditis model . METHODS Sterile pericarditis was created in 20 dogs r and omly assigned to two groups : a control group ( 10 dogs ) and an atorvastatin treatment group ( 10 dogs ) . Atorvastatin was administered orally ( 2 mg/kg/day ) beginning 1 week before the operation until the end of the study . Before and 2 days after the operation , CRP levels , the duration of induced AF , the atrial effective refractory period ( AERP ) , and intra-atrial conduction time were determined . RESULTS Before the operation , there were no significant differences in any of the parameters between the two groups . On the second postoperative day , the atorvastatin group had a lower CRP level ( 7.6+/-0.5 versus 11.7+/-1.3 mg/dl , P<0.0001 ) , a shorter AF duration ( 177+/-57 versus 534+/-189 s , P<0.0001 ) , a longer AERP ( 138+/-6 versus 130+/-6 ms , P<0.01 ) , and a shorter intra-atrial conduction time ( 46+/-3 versus 51+/-5 ms , P<0.01 ) than the control group . CONCLUSIONS Atorvastatin can prevent maintenance of AF by inhibiting inflammation in the canine sterile pericarditis model . Atorvastatin may thus be a novel therapeutic agent for AF Background : Atorvastatin has been demonstrated to reduce the incidence of postoperative atrial fibrillation ( POAF ) in patients undergoing cardiac surgery , but its effect on isolated heart valve surgery is unknown . Methods : In a r and omized , double-blinded , placebo-controlled trial , 58 patients who underwent isolated heart valve surgery supported by on-pump cardiopulmonary bypass were r and omly assigned to receive either placebo ( n = 29 ) or 40 mg of atorvastatin once daily starting 3 days preoperatively and continuing within 5 days postoperatively ( n = 29 ) . A continuous monitoring tool and an electrocardiographic Holter monitoring were used for detecting the POAF ( Clinical Trial Registration : www . clinical trials.gov ; Unique Identifier : NTC02084069 ) . Results : The patients ’ median age was 49 years , and 67 % were female . In all , 6 ( 21 % ) and 13 ( 45 % ) cases of POAF were observed in the atorvastatin and placebo groups , respectively ( P = .050 ) . The duration of AF before re-establishment of sinus rhythm was significantly lower in the atorvastatin group than in the placebo group ( median of 70 vs 132 minutes , P = .026 ) . The lengths of intensive care unit and hospital stay were comparable between the groups . The increase in postoperative white blood cell count was significantly lower in the atorvastatin group than in the placebo group ( median of 1.5 vs 2.3 × 103/µL , respectively , P = .019 ) . After adjustment , the atorvastatin treatment was associated with a decrease in the risk of developing POAF ( odds ratio 0.122 , 95 % confidence interval 0.027 - 0.548 , P = .006 ) . Conclusion : Perioperative treatment with 40 mg of atorvastatin is useful to decrease the incidence of POAF in the statin-naive patients undergoing isolated heart valve surgery BACKGROUND The purpose of the present study was to assess the preventive effect of preoperative statin treatment on  atrial fibrillation ( AF ) after elective isolated off-pump coronary artery bypass grafting ( off-pump CABG ) in propensity score-matched Japanese patients . METHODS AND RESULTS Among 770 consecutive patients undergoing isolated CABG by the same surgeon ( 99.2 % with off-pump technique without conversion to cardiopulmonary bypass ) between 2002 and 2009 , after excluding emergency ( n=150 ) , chronic AF ( n=30 ) , and use of cardiopulmonary bypass ( n=6 ) , 584 patients were retrospectively review ed . Of this cohort , 364 patients received statin  at least 5 days before operation and 220 patients received no statin . We identified 195 propensity score-matched pairs . Propensity scores were created based on 8 preoperative factors ( C statistics , 0.69 ) . There was no significant difference between the 2 groups in baseline characteristics , perioperative medications , or operative procedures . AF occurred in 14.4 % in the statin group and in 24.6 % in the no statin group ( P=0.01 ) . Multivariate logistic regression including potential univariate predictors identified statin ( odds ratio [ OR ] = 0.49 ; 95 % confidence interval [ 95%CI ] = 0.22 - 0.81 ; P=0.01 ) , age ( OR = 1.33 per 10-year increase ; 95%CI = 1.04 - 1.69 ; P=0.02 ) , and transfusion ( OR = 2.21 ; 95%CI = 1.38 - 3.55 ; P=0.01 ) as independent predictors of postoperative AF . CONCLUSIONS Preoperative statin significantly reduces the incidence of AF after elective isolated off-pump CABG in Japanese patients
SUMMARY The use of statins was significantly associated with a decreased risk of atrial fibrillation in patients with sinus rhythm .
PURPOSE OF REVIEW Whether statins may prevent  atrial fibrillation  remains a subject of debate .