A Meta-analysis on Randomized Controlled Trials of Statins to Prevent Atrial Fibrillation_Chinese Journal of Evidence-Based Medicine

Authors：

SHI Wei , LIU Zengzhang , SU Li ,  YIN Yuehui

Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;

Corresponding author：

YIN Yuehui, Email: yinyuehui63@yahoo.com.cn

Keywords：

Statins; Atrial fibrillation; Meta-analysis

DOI：

10.7507/1672-2531.20090104

Video：

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Objective 　To synthesize the available evidence on the efficacy of using statins in the prevention of recurrent and new-onset atrial fibrillation (AF).
Methods 　We searched PubMed, EMbase, EMB Reviews-Cochrane Central Register of Controlled Trials (Issue 3, 2007), CBMdisc, VIP, and CNKI databases from establishment to 15th Sep. 2007 to identify randomized controlled trials (RCTs) covering the use of statins for the patients with persistent AF after electrical cardioversion, paroxysmal and postoperative AF. Meta-analysis was performed using RevMan 4.3 software after the strict evaluation of the methodological quality of the included RCTs.
Results 　Five RCTs including 470 patients were included. Significant heterogeneity was found when the data were pooled, so a random effect model was used for metaanalysis. Compared with placebo or no use of statins, the statins decreased risk of AF recurrence and postoperative AF (RR=0.61, 95%CI 0.43 to 0.88, P=0.008). Sensitivity analysis showed that the result was stable. The fail-safe number was 52.91.
Conclusion 　The statins may decrease incidence of AF recurrence and postoperative AF. Because of the low quality and the small number of included studies, larger sample-size, randomized, double-blinded controlled trials are needed.

Citation： SHI Wei,LIU Zengzhang,SU Li,YIN Yuehui. A Meta-analysis on Randomized Controlled Trials of Statins to Prevent Atrial Fibrillation. Chinese Journal of Evidence-Based Medicine, 2009, 09(5): 570-573. doi: 10.7507/1672-2531.20090104 Copy

1.	inflammation in a canine sterile pericarditis model. Cardiovasc Res, 2004, 62(1): 105-111.
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3.	Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
4.	Tveit A, Grundtvig M, Gundersen T, et al. Analysis of pravastatin to prevent recurrence of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2004, 93(6): 780-782.
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6.	Ozaydin M, Varol E, Aslan SM, et al. Effect of atorvastatin on the recurrence rates of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2006, 97(10): 1490-1493.
7.	Patti G, Chello M, Candura D, et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation, 2006, 114(14): 1455-1461.
8.	周培荣, 张士森, 刘玉珍. 胺碘酮与辛伐他汀联用治疗阵发性心房颤动的临床研究. 滨州医学院学报, 2007, 30(3): 183-184.
9.	麦劲壮, 李河, 方积乾, 等. Meta分析中失安全系数的估计. 循证医学, 2006, 6(5): 297-303.
10.	周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究. 中华内科杂志, 2004, 43(7): 491-494.
11.	Lijnen P, Celis H, Fagard R, et al. Influence of cholesterol lowering on plasma membrane lipids and cationic transport systems. J Hypertens, 1994, 12(1): 59-64.
12.	Tesfamariam B, Frohlich BH, Gregg RE, et al. Differential effects of pravastatin, simvastatin, and atorvastatin on Ca2+ release and vascular reactivity. J Cardiovasc Pharmacol, 1999, 34(1): 95-101.
13.	Bolotina V, Omelyanenko V, Heyes B, et al. Variations of membrane cholesterol alter the kinetics of Ca2+-dependent K+ channels and membrane fluidity in vascular smooth muscle cells. Pflugers Arch, 1989, 415(3): 262-268.
14.	Engelmann M, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J, 2005, 26(20): 2083-2092.
15.	Kumagai K, Nakashima H, Saku K. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting.
16.	Hayashidani S, Tsutsui H, Shiomi T, et al. Fluvastatin, a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, attenuates left ventricular remodeling and failure after experimental myocardial infarction. Circulation, 2002,105 (7): 868-873.
17.	Porter KE, Turner NA, 0’Regan DJ, et al. Simvastatin reduces human atrial myofibroblast proliferation independently of cholesterol lowering via inhibition of RhoA. Cardiovasc Res, 2004, 61(4): 745-755.
18.	Shiroshita-Takeshita A, Schram G, Lavoie J, et al. Effect of simvastatin and antioxidant vitamins on atrial fibrillation promotion by atrial-tachycardia remodeling in dogs. Circulation, 2004, 110(16): 2313-2319.
19.	Pliquett RU, Cormish KG, Peuler JD, et al. Simvastatin normalizes autonomic neural control in experimental heart failure. Circulation, 2003, 107(19): 2493-2498.
20.	Welzig CM, Shin DG, Park HJ, et al. Lipid lowering by pravastatin increases parasympathetic modulation of heart rate: Galpha(i2), a possible molecular marker for parasympathetic responsiveness. Circulation, 2003, 108(22): 2743-2746.

1. inflammation in a canine sterile pericarditis model. Cardiovasc Res, 2004, 62(1): 105-111.
2. Moher D, Schulz KF, Altman D. CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallelgroup randomized trials. JAMA, 2001, 285(15): 1987-1991.
3. Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
4. Tveit A, Grundtvig M, Gundersen T, et al. Analysis of pravastatin to prevent recurrence of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2004, 93(6): 780-782.
5. Dernellis J, Panaretou M. Effect of C-reactive protein reduction on paroxysmal atrial fibrillation. Am Heart J, 2005, 150(5): 1064.
6. Ozaydin M, Varol E, Aslan SM, et al. Effect of atorvastatin on the recurrence rates of atrial fibrillation After electrical cardioversion. Am J Cardiol, 2006, 97(10): 1490-1493.
7. Patti G, Chello M, Candura D, et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation, 2006, 114(14): 1455-1461.
8. 周培荣, 张士森, 刘玉珍. 胺碘酮与辛伐他汀联用治疗阵发性心房颤动的临床研究. 滨州医学院学报, 2007, 30(3): 183-184.
9. 麦劲壮, 李河, 方积乾, 等. Meta分析中失安全系数的估计. 循证医学, 2006, 6(5): 297-303.
10. 周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究. 中华内科杂志, 2004, 43(7): 491-494.
11. Lijnen P, Celis H, Fagard R, et al. Influence of cholesterol lowering on plasma membrane lipids and cationic transport systems. J Hypertens, 1994, 12(1): 59-64.
12. Tesfamariam B, Frohlich BH, Gregg RE, et al. Differential effects of pravastatin, simvastatin, and atorvastatin on Ca2+ release and vascular reactivity. J Cardiovasc Pharmacol, 1999, 34(1): 95-101.
13. Bolotina V, Omelyanenko V, Heyes B, et al. Variations of membrane cholesterol alter the kinetics of Ca2+-dependent K+ channels and membrane fluidity in vascular smooth muscle cells. Pflugers Arch, 1989, 415(3): 262-268.
14. Engelmann M, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J, 2005, 26(20): 2083-2092.
15. Kumagai K, Nakashima H, Saku K. The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting.
16. Hayashidani S, Tsutsui H, Shiomi T, et al. Fluvastatin, a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, attenuates left ventricular remodeling and failure after experimental myocardial infarction. Circulation, 2002,105 (7): 868-873.
17. Porter KE, Turner NA, 0’Regan DJ, et al. Simvastatin reduces human atrial myofibroblast proliferation independently of cholesterol lowering via inhibition of RhoA. Cardiovasc Res, 2004, 61(4): 745-755.
18. Shiroshita-Takeshita A, Schram G, Lavoie J, et al. Effect of simvastatin and antioxidant vitamins on atrial fibrillation promotion by atrial-tachycardia remodeling in dogs. Circulation, 2004, 110(16): 2313-2319.
19. Pliquett RU, Cormish KG, Peuler JD, et al. Simvastatin normalizes autonomic neural control in experimental heart failure. Circulation, 2003, 107(19): 2493-2498.
20. Welzig CM, Shin DG, Park HJ, et al. Lipid lowering by pravastatin increases parasympathetic modulation of heart rate: Galpha(i2), a possible molecular marker for parasympathetic responsiveness. Circulation, 2003, 108(22): 2743-2746.

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Chinese Journal of Evidence-Based Medicine

A Meta-analysis on Randomized Controlled Trials of Statins to Prevent Atrial Fibrillation

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