A region-wide study in greater than 50,000 patients with atrial fibrillation found reduced stroke risks and transient ischaemic attack in those that began statins inside a yr of diagnosis compared with those that didn’t. The findings are presented at EHRA 2023, the European Society of Cardiology (ESC) scientific congress.

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“Our study indicates that taking statins for a few years was much more protective against stroke than short-term use,” said study writer Ms. Jiayi Huang, a Ph.D. student on the University of Hong Kong, China.

Atrial fibrillation is probably the most common heart rhythm disorder, affecting greater than 40 million people worldwide. Patients with the condition have a five times greater risk of stroke than their peers. Anticoagulant medication is really helpful to stop strokes in those with atrial fibrillation but doesn’t entirely eliminate risk. As well as, Statin therapy is widely prescribed to lower blood cholesterol and reduce the likelihood of heart attack and stroke. Nonetheless, the advantage of statins for stroke prevention in patients with atrial fibrillation has been unclear.

This study evaluated the association between statin use and the incidence of stroke and transient ischaemic attack in patients with atrial fibrillation. The researchers used the Hong Kong Clinical Data Evaluation and Reporting System to discover all patients with a recent diagnosis of atrial fibrillation between 2010 and 2018. Participants were divided into two groups: statin users and non-users. Users had received statins for a minimum of 90 consecutive days in the course of the yr after being diagnosed with atrial fibrillation.

The first outcomes were the combined endpoint of ischaemic stroke or systemic embolism, hemorrhagic stroke, and transient ischaemic attack. Patients were followed until the occurrence of the first outcomes, death, or the tip of the study on 31 October 2022. 

A complete of 51,472 patients with a recent diagnosis of atrial fibrillation were included, of which 11,866 were classified as statin users, and 39,606 were non-users. The median age of participants was 75 years, and 48% were women. During a median follow-up of 5 years, statin users had a significantly lower risk of all primary outcomes in comparison with non-users. For instance, Statin use was related to a 17% reduced risk of ischaemic stroke or systemic embolism (hazard ratio [HR] 0.83; 95% confidence interval [CI] 0.78–0.89), a 7% reduced risk of hemorrhagic stroke (HR 0.93; 95% CI 0.89–0.98) and a 15% reduced risk of transient ischaemic attack (HR 0.85; 95% CI 0.80–0.90).

The researchers also found that long-term statin use was related to greater protection than short-term use. In comparison with those taking the medication for between three months and two years, patients using statins for six years or longer had a 43% lower risk of ischaemic stroke or systemic embolism (HR 0.57; 95% CI 0.54–0.61), 44% reduced likelihood of hemorrhagic stroke (HR 0.56; 95% CI 0.53–0.60) and 42% reduced risk of transient ischaemic attack (HR 0.58; 95% CI 0.52–0.64). These associations were consistent no matter whether or not patients used anticoagulant medication and the kind of anticoagulant.

Ms. Huang said: “These data support using statins to stop stroke and transient ischaemic attack in patients with new-onset atrial fibrillation. The findings have vital clinical implications, particularly on condition that in atrial fibrillation patients, ischaemic strokes are sometimes fatal or disabling and have a high risk of reoccurrence.”

Related papers of interest

• Daniele, Pastori., Daniele, Pastori., Francesco, Baratta., Arianna, Di, Rocco., Alessio, Farcomeni., Maria, Del, Ben., Francesco, Angelico., Francesco, Violi., Pasquale, Pignatelli., Gregory, Y.H., Lip. (2021). Statin use and mortality in atrial fibrillation: A scientific review and meta-analysis of 100,287 patients. Pharmacological Research, 165, 105418-. doi: 10.1016/J.PHRS.2021.105418,  https://www.sciencedirect.com/science/article/pii/S1043661821000013
• Mi-Yeon, Eun., Jin, Man, Jung., Kang-Ho, Choi., Woo-Keun, Search engine optimization. (2020). Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Evaluation.. Frontiers in Neurology, 11, 589684-589684. doi: 10.3389/FNEUR.2020.589684, https://www.frontiersin.org/articles/10.3389/fneur.2020.589684/full
• Aakriti, Gupta., Mahesh, V., Madhavan., Timothy, J., Poterucha., Ersilia, M., DeFilippis., Jessica, A., Hennessey., Björn, Redfors., Björn, Redfors., Christina, Eckhardt., Behnood, Bikdeli., Behnood, Bikdeli., Jonathan, Platt., Ani, Nalbandian., Pierre, Elias., Matthew, J., Cummings., Shayan, Nabavi, Nouri., Matthew, Lawlor., Lauren, S., Ranard., Jianhua, Li., Claudia, Boyle., Raymond, Givens., Daniel, Brodie., Harlan, M., Krumholz., Gregg, W., Stone., Sanjum, S., Sethi., Daniel, Burkhoff., Nir, Uriel., Allan, Schwartz., Martin, B., Leon., Ajay, J., Kirtane., Elaine, Wan., Sahil, A., Parikh. (2021). Association between antecedent statin use and decreased mortality in hospitalized patients with COVID-19.. Nature Communications, 12(1), 1325-1325. doi: 10.1038/S41467-021-21553-1, https://www.nature.com/articles/s41467-021-21553-1