Lipid-lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction

BACKGROUND Inflammation and oxidative stress have been implicated in the pathogenesis of atrial fibrillation (AF). Lipid-lowering drugs, particularly statins and fibrates, possess antiinflammatory and antioxidant properties. OBJECTIVES The purpose of this study was to assess the impact of lipid-lowering drug use on AF prevalence in patients with reduced left ventricular ejection fraction (LVEF). METHODS Data were obtained from ADVANCENT(SM), a multicenter registry of patients with reduced LVEF (<= 40%). Demographic, clinical, and echocardiographic parameters were collected from interviews and medical records. Medications, including lipid-lowering drugs, were recorded. RESULTS Of the 25,268 patients, 71.3% had hyperlipidemia, and 66.8% were prescribed lipid-lowering drugs. AF prevalence was 25.1% in patients taking lipid-lowering drugs compared with 32.6% in untreated hyperlipidemic patients and 32.8% in patients without hyperlipidemia (P <.001 for both comparisons). In multivariable analysis, lipid-lowering drug use remained significantly associated with reduced odds of AF (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.64-0.74), and this effect was Larger than that of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR 0.85, 95% CI 0.79-0.92) or beta-blockers (OR 0.95, 95% CI 0.88-1.02). The beneficial impact of Lipid-lowering drugs on AF risk was independent of their effects on the Lipid profile. In patients in whom data on specific lipid-Lowering drugs were available, 92% of the patients undergoing Lipid-Lowering therapy received statins, and 98% received statins and/or fibrates. CONCLUSION Use of Lipid-Lowering drugs in patients with reduced LVEF is associated with a significant reduction in the prevalence of AF independent of the Lipid profile and other known arrhythmia risk factors. This effect is Larger than that of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or beta-blockers and may be the result of the antioxidant and anti-inflammatory effects of statins and fibrates.