European Society of Cardiology
Barcelona, Spain
A region-wide study of more than 50,000 patients with atrial fibrillation found a reduced risk of stroke and transient ischemic attack in those who started taking statins within a year of diagnosis compared with those who did not. The findings are presented at EHRA 2023, a scientific conference of the European Society of Cardiology (ESC).
“Our study indicates that taking statins for many years was even more protective against stroke than short-term use,” said study author Ms. Jiayi Huang, a doctoral student at the University of Hong Kong, China.
Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting more than 40 million people worldwide.
Patients with AF have a five-fold higher risk of stroke than their peers. Anticoagulant medication is recommended to prevent strokes in people with atrial fibrillation, but it does not completely eliminate the risk. Statin therapy is widely prescribed to lower blood cholesterol and reduce the likelihood of heart attack and stroke. However, the benefit 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 ischemic attack in patients with atrial fibrillation. The researchers used the Hong Kong Clinical Data Analysis and Reporting System to identify all patients with a new diagnosis of atrial fibrillation between 2010 and 2018. Participants were divided into two groups: statin users and non-users. Users had received statins for at least 90 consecutive days during the year after atrial fibrillation diagnosis.
The primary outcomes were the composite endpoint of ischemic stroke or systemic embolism; brain-vascular hemorrhagic accident; and transient ischemic attack. Patients were followed until the onset of primary outcomes, death, or the end of the study on October 31, 2022.
A total of 51,472 patients with a new diagnosis of atrial fibrillation were included , of which 11,866 were classified as statin users and 39,606 as non-users. The median age of the participants was 75 years and 48% were women. During a median follow-up of five years , statin users had a significantly lower risk of all primary outcomes compared with non-users.
Statin use was associated with a 17% reduction in the risk of ischemic stroke or systemic embolism (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.78–0.89) , a 7% reduction in the risk of hemorrhagic stroke (HR 0.93; 95% CI 0.89–0.98) and a 15% lower risk of transient ischemic attack (HR 0.85; 95% CI 0.80–0.90).
The researchers also found that long-term statin use was associated with greater protection than short-term use.
Compared with those who took the drug for three months to two years, patients who used statins for six years or more had a 43% lower risk of ischemic stroke or systemic embolism (HR 0.57; 95% CI 0.57). 54–0.61), 44% lower risk of hemorrhagic stroke (HR 0.56; 95% CI 0.53–0.60), and 42% lower risk of transient ischemic attack (HR 0.58; 95% CI 0.53–0.60). 95% 0.52–0.64). These associations were consistent regardless of whether or not patients used anticoagulant medication and the type of anticoagulant.
Ms Huang said: “These data support the use of statins to prevent stroke and transient ischemic attack in patients with new-onset atrial fibrillation. "The findings have important clinical implications, particularly given that in patients with atrial fibrillation, ischemic strokes are often fatal or disabling, and have a high risk of recurrence."
