Abstract 12786: Combination Therapy with Renin-Angiotensin System Inhibitors and Statins is Associated with Reduced Incidence of New-Onset Atrial Fibrillation in Hypertensive Patients
Background: Several clinical trials have shown that renin-angiotensin system inhibitors (RASIs), i.e., angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs), are associated with lower risk of incident atrial fibrillation (AF). In some recent studies, however, treatment with ARBs was not effective in reducing AF episodes in patients with paroxysmal AF or after cardioversion. Furthermore, controversial findings have been shown on whether AF incidence is favorably affected by statin treatment. This longitudinal observational study investigated the combined effect of RASIs and statins on the new onset of AF in Japanese hypertensives.
Methods: A total of 912 essential hypertensive patients (mean age, 62 years) without previous paroxysmal AF, heart failure, myocardial infarction, or valvular disease were enrolled in this study. At baseline, left atrial (LA) dimension and left ventricular mass index (LVMI) were determined in echocardiographic examinations.
Results: During follow-up periods (mean, 4.6 years), 43 cases of new-onset AF (including paroxysmal AF) were found (1.0%/year). All patients were divided into four groups by the use of RASIs and/or statins during follow-up. The incidence rates of new-onset AF were 6.0% in RASI(-)/statin(-), 4.3% in RASI(+)/statin(-), 3.9% in RASI(-)/statin(+), and 3.5% in RASI(+)/statin(+) group, respectively. By univariate Cox regression analysis, age, smoking, the presence of chronic kidney disease, LA dimension, and LVMI were significantly associated with the occurrence of AF during follow-up. In the multivariate analysis after adjustment for these confounding factors, the use of RASIs or statins had a tendency to decrease the cumulative event rates of new-onset AF (RASIs: HR 0.58, p=0.077; statins: HR 0.52, p=0.067). Interestingly, combined treatment with RASIs and statins was significantly associated with a reduced incidence of AF (HR 0.39, 95%CI 0.16-0.91, p=0.031).
Conclusions: The present study demonstrated that combination therapy with RASIs and statins was associated with a decreased risk of new-onset AF in hypertensive patients. Therefore, RASIs and statins may have an additive or synergistic beneficial effect on the primary prevention of AF in hypertensives.
- © 2012 by American Heart Association, Inc.