Abstract 10603: HMG-CoA Reductase Inhibitors and Risk of Atrial Fibrillation/Flutter among Patients with and without Chronic Kidney Disease
Background: Although it is generally believed that statins may be beneficial to patients with mild to moderate chronic kidney disease (CKD), the role of statin use in patients with and without CKD in reducing atrial fibrillation is unclear.
Methods: The patients who started to take statins between January 1, 2001 and December 31, 2009 were identified from a random sample of one million subjects from the Taiwan National Health Insurance Research Database. The outcome of interest was atrial fibrillation/flutter, defined as defined as having any ICD-9-CM diagnosis code of 427.3 in the inpatient or outpatient database. A proportional hazard regression model with time-varying statin use was applied to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) comparing current statin use versus discontinuation, adjusted for the baseline propensity scores and other time-varying covariates.
Results: A total of 6,767 statin initiators with CKD and 63,678 patients without CKD were included, with an average follow-up of 4.0 years. A total of 1,118 study participants experienced newly-onset atrial fibrillation/flutter occurrence. Generally, atrial fibrillation/flutter incidence was about 2-fold higher in CKD patients as compared with those without CKD. Continuing statin therapy was associated with a 20% decrease in atrial fibrillation/flutter risk as compared with discontinuation in patients without chronic kidney disease (adjusted HR 0.80; 95% CI: 0.67-0.96). A further reduction in risk was noted for patients with CKD (adjusted HR 0.44; 95% CI: 0.28-0.71). The protective association between statin use and atrial fibrillation/flutter occurrence was not modified by other underlying disease.
Conclusion: Statin continuation was associated with a decreased risk of atrial fibrillation/flutter occurrence among patients with and without CKD. The anti-arrhythmia effect was also found in the patients of different ages and co-morbidities.
- © 2012 by American Heart Association, Inc.