Abstract 9522: Hs-CRP, Statin Therapy, and Risks of Atrial Fibrillation: An Exploratory Analysis of the JUPITER Trial
Objective: We studied whether high-sensitivity C-reactive protein (hs-CRP) is associated with incident atrial fibrillation (AF) and whether treatment with rosuvastatin is associated with a lower incidence of AF compared with placebo.
Background: Increasing evidence supports a role for inflammation in promoting AF and statins have anti-inflammatory effects that may be relevant for the prevention of AF. However, studies of statin therapy and incident AF have yielded mixed results and not focused on those with an underlying pro-inflammatory response.
Methods and Results: The JUPITER trial randomized men and women with LDL-C < 130 mg/dL and hs-CRP ≥ 2 mg/dl to receive either rosuvastatin 20 mg daily or placebo. AF was determined from treatment-blind adverse event reports. Among 17,120 JUPITER participants with no prior history of AF or arrhythmia, each increasing tertile of baseline hs-CRP was associated with a 36% increase in the risk of developing AF( 95% CI 1.16-1.60 p-trend <0.01). Random allocation to rosuvastatin as compared with placebo was associated with a 27 percent reduction in the relative risk of developing AF during the trial period; specifically, AF was reported among 138 participants in the placebo group and 100 in the rosuvastatin group (hazard ratio 0.73, 95% CI 0.56-0.94, p=0.01). This association remained significant after multivariate adjustment (adjusted HR for rosuvastatin 0.72, 95% CI 0.55-0.93, p=0.01) as well as in analyses excluding participants who developed a major cardiovascular event prior to the report of AF (adjusted HR for rosuvastatin 0.74, 95% CI 0.57-0.97, p=0.03).
Conclusions: Within the JUPITER trial cohort of individuals selected for underlying inflammation, increasing levels of hs-CRP were associated with an increased risk of incident AF and random allocation to rosuvastatin significantly reduced that risk.
- © 2011 by American Heart Association, Inc.