Statin therapy and atrial fibrillation: systematic review and updated meta-analysis of published randomized controlled trials

Purpose of review Whether statins may prevent atrial fibrillation remains a subject of debate. An updated systematic review of randomized controlled trials with statins that collected data on the incidence or recurrence of atrial fibrillation was performed. Recent findings Thirty-two published studies with 71 005 patients were included in the analysis. Overall, the use of statins was significantly associated with a decreased risk of atrial fibrillation compared with controls [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.57-0.83, P < 0.0001] with heterogeneous results. The benefit of statin therapy appeared highly significant for the prevention of postoperative atrial fibrillation (homogeneous OR 0.37, 95% CI 0.28-0.51, P < 0.00001). Benefit was not apparent for the prevention of new-onset atrial fibrillation (OR 1.00, 95% CI 0.86-1.15, P = 0.95) but was significant for secondary prevention of atrial fibrillation (OR 0.57, 95% CI 0.36-0.91, P = 0.02 with significant heterogeneity). There was no reduction in the risk of atrial fibrillation with more intensive vs. standard statin regimens (OR 1.01, 95% CI 0.77-1.32, P = 0.96). Summary The use of statins was significantly associated with a decreased risk of atrial fibrillation in patients with sinus rhythm. The highest benefit was seen for the prevention of postoperative atrial fibrillation and in secondary prevention of atrial fibrillation, with a heterogeneity that deserves further clarification.