Observation Of Fluvastatinon Alone Or In Combination With Valsartan On Patients With Atrial Fibrillation

Objective:1.To investigate the upstream therapeutic effect of fluvastatin and valsartan on hypertension patients with non-permanent atrial fibrillation.2.To observe the clinical effect of fluvastatin on paroxysmal atrial fibrillation.Methods: 1.From February 2013 to July 2016,143 cases of patients whom were admitted to outpatient and inpatient department of Second Hospital of Tianjin Medical University,Tianjin People’s Hospital,Tianjin Dongli Hospital and other 5hospitals,diagnosed as hypertension with non-permanent atrial fibrillation,were divided into three groups randomly: calcium antagonists(CCB)group(n=45),CCB+fluvastatin group(n=48),valsartan + fluvastatin group(n=50).Treatment plan: CCB group used dihydropyridines,but limited to the use of amlodipine,nifedipine and felodipine.Fluvastatin + CCB group: fluvastatin 40~80mg q.n.+CCB;fluvastatin +valsartan group: fluvastatin 40~80mg q.n.+ valsartan,three groups were followed up for 24 months.Keeping observation of the maintenance rate of sinus rhythm,the recurrence of paroxysmal atrial fibrillation or persistent atrial fibrillation incidence,burden of atrial fibrillation,heart rate variability,and left atrial diameter(LAD),high sensitive C reactive protein(hs-CRP),the change of blood lipid liver(TG,TC,LDL-C)and kidney function index of these groups before and after 24 months’ treatment.2.From July 2014 to July 2016,a total of 80 patients with paroxysmal atrial fibrillation whom were enrolled in Second Hospital of Tianjin Medical University were divided into two groups randomly:(n=40)and control group(n=40).The control group received antiarrhythmic drugs,the observation group received fluvastatin based on the use of antiarrhythmic drugs,two groups were followed up for one year.The maintenance rate of sinus rhythm and persistent atrial fibrillation the LAD rate,hs-CRP,blood lipids,liver and kidney function index were observed before and compared before and after treatment.Results: 1.After 24 months of treatment,there were 143 cases of patients who have completed the study.There was 41 patients in CCB group,45 patients in CCB +fluvastatin group,and 48 patients in valsartan + fluvastatin group.There were no significant differences in age,sex,smoking,drinking,diabetes,stroke,amiodarone medication history,and blood glucose,myocardial enzymes(CK-MB,cTnI),NT-ProBNP,blood pressure,liver function(ALT,AST),renal function(Cr),blood lipids(TG,TC,LDL-C)of three groups(P>0.05).(1)The sinus rhythm maintenance rate of fluvastatin + CCB group,fluvastatin + valsartan group was higher than CCBgroup(77.78%,79.19% vs 43.90%),the occurrence of persistent atrial fibrillation was significantly lower than CCB group [5(11.11%),4(8.33%)vs 13(31.71%)](P<0.05);(2)The paroxysmal AF duration of fluvastatin + CCB group,fluvastatin +valsartan group were decreased compared with CCB group [8.4%(5.8%,14.4%),10.4%(4.5%,13.9%)vs 23.4%(15.4%,29.8%)](P<0.05);(3)The f-f interval and f wave amplitude of fluvastatin + CCB group,fluvastatin + valsartan after treatment were higher than baseline(P<0.05),while,there were no significant differences of these indexes in CCB group before and after treatment(P>0.05).(4)There were no significant difference of blood lipids,hs-CRP and LAD before and after treatment of CCB group(P>0.05),while,these indexes was significantly reduced in CCB +fluvastatin group and fluvastatin + valsartan group before and after treatment(P<0.05).(5)There was no significant difference in liver and renal function of each group before and after treatment(P>0.05).2.After 12 months of treatment,there were 74 cases of patients who have completed the study.There was 38 patients in fluvastatin group,and 36 patients in the control group.There were no significant differences in age,sex,smoking,drinking,diabetes,stroke,amiodarone medication history,and blood glucose,myocardial enzymes(CK-MB,cTnI),NT-ProBNP,blood pressure,liver function(ALT,AST),renal function(Cr),blood lipids(TG,TC,LDL-C)of two groups(P>0.05).After treatment the sinus rhythm maintenance rate of fluvastatin group was significantly higher than the control group(84.21% vs 61.11%),persistent atrial fibrillation was significant lower than the control group(5.26% vs 22.22%)(P<0.05).There were not significant differences of serum lipid,hs-CRP and left atrial diameter in the control group(P>0.05),while those indexes of the observation group were significantly lower than baseline(P<0.05).The serum lipids,hs-CRP and left atrial diameter were significantly lower than the control group after treatment(P<0.05).There was no significant difference between both groups before and after the treatment of liver and kidney function(P>0.05).Conclusions: Adding fluvastatin on the basis of conventional antiarrhythmic therapy for treatment with non-permanent atrial fibrillation,not only could reduce blood lipids,but also further improve the sinus rhythm maintenance rate,reduce the recurrence rate of paroxysmal atrial fibrillation and AF burden,reduce the incidence of persistent atrial fibrillation,improve atrial remodeling,reduce inflammation reaction,and didn’t increase adverse reaction of liver and kidney dysfunction,which provided evidence of fluvastatin and valsartan for the secondary prevention andtreatment of atrial fibrillation.