Objective.
We sought to determine among people whose initial atrial fibrillation (AF) terminated whether use of statins, beta-blockers, and ACE inhibitors or ARBs was associated with lower risk of recurrent AF or progression to permanent AF.
Methods.
In Group Health, an integrated health care system, we identified an inception cohort of people aged 30-84 with newly diagnosed AF in 2001-2004 whose initial AF terminated within six months. Follow-up was through 2009. Medication use throughout follow-up was determined from the pharmacy database. Recurrent AF and permanent AF were determined from medical records and ECG and procedure code databases. Permanent AF was defined as AF present on two dates at least six months apart with no evidence of sinus rhythm in between. Cox proportional hazards models were used to estimate hazard ratios. We compared current statin use with nonuse. To reduce healthy user bias, we compared statin use one year prior with nonuse one year prior. To reduce confounding by indication, we compared beta-blocker use with nondihydropyridine calcium channel blocker use. We compared current ACE inhibitor or ARB use with nonuse.
Results.
Analyses included 1,511 people. Mean age was 70 years and 51% were men. Statins were used for 36% of person-time, beta-blockers for 48%, and ACE inhibitors or ARBs for 42%. Five-year cumulative incidence of recurrent AF was 74% and of permanent AF was 24%. Current statin use vs. nonuse was associated with lower permanent AF risk. However, statin use vs. nonuse one year prior was not associated with permanent AF (
Table
). Use of beta-blockers and ACE inhibitors or ARBs was not associated with recurrent AF or permanent AF.
Adjusted hazard ratios of recurrent AF and permanent AF according to medication use.
Medication use
Recurrent AF Adjusted HR
*
(95% CI)
Permanent AF Adjusted HR
*
(95% CI)
Statins -- current use analysis
Nonuse
1.00 (reference)
1.00 (reference)
Current use
0.96 (0.82, 1.12)
0.76 (0.58, 0.99)
Statins -- lagged analysis
Nonuse one year prior
1.00 (reference)
1.00 (reference)
Use one year prior
0.94 (0.79, 1.13)
0.98 (0.74, 1.30)
Beta-blockers
Current nondihydropyridine CCB use
1.00 (reference)
1.00 (reference)
Current beta-blocker use
0.91 (0.74, 1.12)
1.04 (0.69, 1.56)
ACE inhibitors or ARBs
Nonuse
1.00 (reference)
1.00 (reference)
Current use
0.99 (0.86, 1.14)
0.98 (0.77, 1.25)
*
Adjusted for age, sex, BMI, diabetes, hypertension, coronary heart disease, valvular heart disease, heart failure, prior stroke, and chronic kidney disease.
Conclusion.
The lagged statin analysis suggests that the association of current statin use with lower permanent AF risk may have been due to an acute effect of statins that did not persist after discontinuation of use, or to a healthy user bias. We found little evidence that use of statins, beta-blockers, or ACE inhibitors or ARBs reduces risk of recurrent AF or permanent AF.
Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease