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Lipid-lowering combo did not prevent new-onset atrial fibrillation

NEW YORK (Reuters Health) – The combination of simvastatin and ezetimibe failed to cut down on new-onset atrial fibrillation (AF) in patients with asymptomatic aortic stenosis, according to findings from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.

Dr. Casper N. Bang from Rigshospitalet, Copenhagen, Denmark, who led the study, expressed surprise. “Forty milligrams of simvastatin did not lower the incidence of new onset AF; however, this dosage might have been too low,” he told Reuters Health by email.

American and European guidelines suggest that statins might help prevent AF, but published studies have yielded conflicting results.

Dr. Bang and colleagues tested the effect of simvastatin 40 mg and ezetimibe 10 mg in a randomized study of 1,421 asymptomatic patients with mild-to-moderate aortic stenosis. They reported their findings last month in the American Heart Journal,

New-onset AF developed in 44 patients in the treatment group and 41 patients in the placebo group (for statistically similar rates of 14.2 vs 13.7/1000 person-years). There was also no difference in median time to new-onset AF with treatment vs placebo (1566 vs 1578 days).

In multivariable risk calculations, there was no effect of treatment with simvastatin and ezetimibe on the incidence of new-onset AF.

Multivariable prediction models did show a 7% higher AF risk for every year increase in age and a 1.8% higher risk for each increase in g/m2 of left ventricular mass index.

New-onset AF, in turn, was associated with a 65% increased risk of aortic stenosis-related events and with a fourfold proportional increase in the risk of nonfatal nonhemorrhagic stroke. There was no significant association between new-onset AF and the risk of all-cause mortality.

Other alternatives that might reduce the risk of new-onset AF in patients like these, Dr. Bang said, include “aortic valve replacement, antihypertensive medicine (e.g., beta-blockers to avoid left atrial dilatation), and higher doses of statins (40 mg simvastatin is not enough).”

This study doesn’t rule out possible benefits of statins in this setting. Dr. Bang added, “I have two other articles coming up with positive results of statins on AF.”

SOURCE: http://bit.ly/Lo0aqK

Am Heart J 2012;163:690-696.