Hydroxymethylglutaryl-CoA Reductase Inhibitors In The Prevention Of Atrial Fibrillation: A Meta-Analysis Of Randomized Controlled Trials

BACKGROUND:Current evidence suggests that hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors have emerged as novel drugs in preventing atrial fibrillation (AF). This meta-analysis was designed to assess the effects of HMG-CoA reductase inhibitors in the prevention of AF.METHODS:A systemic literature search in MEDLINE, EMBASE, and Cochrane Controlled Trials Register (CCRT) was performed and randomized controlled trials (RCTs) involving the prevention of AF by HMG-CoA reductase inhibitors were collected. Effect size was expressed as odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis and meta-regression was performed to explore the reason for heterogeneity.RESULTS:A total of 32311 patients from 20 trials entered into this study. Overall, the risk of AF was significantly reduced by HMG-CoA reductase inhibitors (OR,0.59; 95% CI 0.45-0.76), especially in postoperative patients (OR,0.40; 95% CI,0.29-0.56). The effect in secondary prevention (OR,0.40; 95% CI 0.20-0.83) was not superior to primary prevention (OR,0.67; 95% CI 0.51-0.88). Significant beneficial effect was observed in atorvastatin subgroup (OR,0.43; 95% CI 0.27-0.66), especially in atorvastatin 10-40mg subgroup (OR, 0.29; 95% CI0.19-0.45). Besides, the increased age of the patients were accompanied with the decreased effect of atorvastatin on AF (p=0.00447). CONCLUSIONS:This study suggests that HMG-CoA reductase inhibitor therapy is useful for the prevention of AF, especially for postoperative prevention. Atorvastatin is more effective than pravastatin, and its effects relate to both the dose of drug and the age of patients. Yet, the number of trials on separate drugs was still too small and more RCTs are necessary to further support this conclusion.