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Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial).

ABSTRACT: Inflammation and oxidative stress are associated with atrial fibrillation (AF). Statins have antioxidant and anti-inflammatory properties. We tested if atorvastatin reduced AF recurrence after DC cardioversion (CV) by modifying systemic oxidative stress and inflammation (NCT00252967).In a randomized, double-blinded, placebo-controlled trial, patients with atrial fibrillation/flutter (AF) were randomized to receive either atorvastatin 80 mg (n = 33) or placebo (n = 31) before CV. Treatment was continued for 12 months or until AF recurred. Serum oxidative stress markers (ratios of oxidized to reduced glutathione and cysteine, derivatives of reactive oxygen species, isoprostanes) and inflammatory markers (high-sensitivity C- reactive protein [hs-CRP], interleukin-6 [IL-6], interleukin-1?[IL-1?], tumor necrosis factor alpha [TNF?]) were measured at baseline and on follow-up. AF recurred in 22 (66.7%) of atorvastatin and 26 (83.9%) of placebo group (P = 0.2). The adjusted hazard ratio of having recurrence on atorvastatin versus on placebo was 0.99 (95% CI: 0.98-1.01, P = 0.3). There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates (median [IR]: 29 [2-145] days versus 22 [7-70] days, P = 0.9). Although no significant effect was seen on oxidative stress, 2 of 4 inflammatory markers, IL-6 (adjusted OR: 0.59, 95% CI: 0.35-0.97, P = 0.04) and hs-CRP (adjusted OR: 0.59, 95% CI: 0.37-0.95, P = 0.03) were significantly lowered with atorvastatin. Cholesterol levels significantly decreased with atorvastatin (P = 0.03).High-dose atorvastatin did not reduce the recurrence of AF after CV. It reduced selective markers of inflammation without affecting systemic oxidative stress. Failure of atorvastatin to prevent AF recurrence may be due to its failure to affect oxidative stress.

SUBMITTER: Negi S

PROVIDER: S-EPMC3022954 | biostudies-literature | 2011 Apr

REPOSITORIES: biostudies-literature

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Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial).

Negi Smita S Shukrullah Irfan I Veledar Emir E Bloom Heather L HL Jones Dean P DP Dudley Samuel C SC

Journal of cardiovascular electrophysiology 20101013 4

<h4>Background</h4>Inflammation and oxidative stress are associated with atrial fibrillation (AF). Statins have antioxidant and anti-inflammatory properties. We tested if atorvastatin reduced AF recurrence after DC cardioversion (CV) by modifying systemic oxidative stress and inflammation (NCT00252967).<h4>Methods and results</h4>In a randomized, double-blinded, placebo-controlled trial, patients with atrial fibrillation/flutter (AF) were randomized to receive either atorvastatin 80 mg (n = 33) ...[more]

PMID: 20946227

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Project description:What is already known about this subjectAtrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia, and AF is associated with relatively higher all-cause mortality in both men and women. However, there are limited treatment options for AF. Statins are hypothesized to have a benefit against arrhythmias in addition to well-established secondary prevention benefit for atherosclerotic coronary artery disease, yet the data are inconsistentWhat this study addsStatin therapy was significantly associated with a decreased risk of incidence or recurrence of AF. The benefit of statin therapy seemed more markedly in secondary prevention than primary prevention. These results provided some evidence for the benefit of statins beyond their lipid-lowering activityAimsThe use of statins has been suggested to protect against atrial fibrillation (AF) in some clinical observational and experimental studies but has remained inadequately explored. This study was designed to examine whether statins can reduce the risk of AF.MethodsMeta-analysis of randomized, controlled trials with use of statins on incidence or recurrence of AF was performed.ResultsTwenty studies with 23,577 patients were included in the analysis. Seven studies investigated the use of statins in patients with AF, 11 studies investigated the primary prevention of statins in patients without AF, and two studies investigated mixed populations of patients. The incidence or recurrence of AF occurred in 1543 patients. Overall, statin therapy was significantly associated with a decreased risk of AF compared with control (odds ratio 0.49, 95% confidence interval 0.37-0.65; P < 0.00001). A beneficial effect was found in the atorvastatin subgroup and the simvastatin subgroup, but not in the pravastatin subgroup or the rosuvastatin subgroup. The benefit of statin therapy appeared to be more pronounced in secondary prevention (odds ratio 0.34, 95% confidence interval 0.18-0.64; P < 0.0008) than in primary prevention (odds ratio 0.54, 95% confidence interval 0.40-0.74; P < 0.0001).ConclusionsStatin therapy was significantly associated with a decreased risk of incidence or recurrence of AF. Heterogeneity was explained by differences in statin types, patient populations and surgery types. The benefit of statin therapy seemed more pronounced in secondary than in primary prevention.

Project description:Background Patients with permanent atrial fibrillation have poor outcomes, exercise capacity, and quality of life even on optimal anticoagulation. Based on mechanistic and observational data, we tested whether the mineralocorticoid receptor antagonist spironolactone can improve exercise capacity, E/e' ratio, and quality of life in patients with permanent atrial fibrillation and preserved ejection fraction. Methods and Results The double-masked, placebo-controlled IMPRESS-AF (Improved Exercise Tolerance in Heart Failure With Preserved Ejection Fraction by Spironolactone on Myocardial Fibrosis in Atrial Fibrillation) trial (NCT02673463) randomized 250 stable patients with permanent atrial fibrillation and preserved left ventricular ejection fraction to spironolactone 25 mg daily or placebo. Patients were followed for 2 years. The primary efficacy outcome was peak oxygen consumption on cardiopulmonary exercise testing at 2 years. Secondary end points included 6-minute walk distance, E/e' ratio, quality of life, and hospital admissions. Spironolactone therapy did not improve peak oxygen consumption at 2 years (14.0 mL/min per kg [SD, 5.4]) compared with placebo (14.5 [5.1], adjusted treatment effect, -0.28; 95% CI, -1.27 to 0.71]; P=0.58). The findings were consistent across all sensitivity analyses. There were no differences in the 6-minute walking distance (adjusted treatment effect, -8.47 m; -31.9 to 14.9; P=0.48), E/e' ratio (adjusted treatment effect, -0.68; -1.52 to 0.17, P=0.12), or quality of life (P=0.74 for EuroQol-5 Dimensions, 5-level version quality of life questionnaire and P=0.84 for Minnesota Living with Heart Failure). At least 1 hospitalization occurred in 15% of patients in the spironolactone group and 23% in the placebo group (P=0.15). Estimated glomerular filtration rate was reduced by 6 mL/min in the spironolactone group with <1-unit reduction in controls (P<0.001). Systolic blood pressure was reduced by 7.2 mm Hg (95% CI, 2.2-12.3) in the spironolactone group versus placebo (P=0.005). Conclusions Spironolactone therapy does not improve exercise capacity, E/e' ratio, or quality of life in patients with chronic atrial fibrillation and preserved ejection fraction. Registration UTL: https://www.clinicaltrial.gov; Unique identifier: NCT02673463. EudraCT number 2014-003702-33.

Project description:ObjectiveTo assess whether atrial fibrillation (AF) self-screening stations in general practice waiting rooms improve AF screening, diagnosis, and stroke risk management.Design, settingIntervention study (planned duration: twelve weeks) in six New South Wales general practices (two in rural locations, four in greater metropolitan Sydney), undertaken during 28 August 2020 - 5 August 2021.ParticipantsPeople aged 65 years or more who had not previously been diagnosed with AF, and had appointments for face-to-face GP consultations. People with valvular AF were excluded.InterventionAF self-screening station and software, integrated with practice electronic medical record programs, that identified and invited participation by eligible patients, and exported single-lead electrocardiograms and automated evaluations to patients' medical records.Main outcome measuresScreening rate; incidence of newly diagnosed AF during intervention and pre-intervention periods; prescribing of guideline-recommended anticoagulant medications.ResultsAcross the six participating practices, 2835 of 7849 eligible patients (36.1%) had face-to-face GP appointments during the intervention period, of whom 1127 completed AF self-screening (39.8%; range by practice: 12-74%). AF was diagnosed in 49 screened patients (4.3%), 44 of whom (90%) had CHA2 DS2 -VA scores of 2 or more (high stroke risk). The incidence of newly diagnosed AF during the pre-intervention period was 11 cases per 1000 eligible patients; during the intervention period, it was 22 per 1000 eligible patients (screen-detected: 17 per 1000 eligible patients; otherwise detected: 4.6 per 1000 eligible patients). Prescribing of oral anticoagulation therapy for people newly diagnosed with AF and high stroke risk was similar during the pre-intervention (20 of 24, 83%) and intervention periods (46 of 54, 85%).ConclusionsAF self-screening in general practice waiting rooms is a feasible approach to increasing AF screening and diagnosis rates by reducing time barriers to screening by GPs. AF self-screening could reduce the number of AF-related strokes.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620000233921 (prospective).

Dataset Information

Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial).

Publications

Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial).

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