Patricia A Howard1, Brian J Barnes. 1. Department of Pharmacy Practice, School of Pharmacy, University of Kansas Medical Center, Kansas City, KS 66160, USA. phoward@kumc.edu
Abstract
OBJECTIVE: To review the published literature evaluating the effectiveness of statin therapy for preventing postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery. DATA SOURCES: A MEDLINE search was performed (1950-October 2007) using the search terms statins, HMG-CoA reductase inhibitors, coronary artery bypass graft, cardiac surgery, and atrial fibrillation. STUDY SELECTION AND DATA EXTRACTION: All articles published in English describing or evaluating the use of statins in humans to prevent atrial fibrillation (AF) were included. Additional pertinent articles were identified from reference lists. DATA SYNTHESIS: POAF is a common complication following CABG surgery that is associated with significant morbidity. Current preventive strategies include the use of beta-blockers and antiarrhythmic drugs such as amiodarone and sotalol. Accumulating evidence suggests that statins may also reduce the risk of POAF. Numerous studies in nonsurgical cardiovascular patients have found reduced rates of AF with statins. In patients who have undergone CABG, several observational studies have also documented benefit. One randomized controlled trial reported a significant reduction in the risk of POAF and reduced length of hospital stay in patients given preoperative atorvastatin beginning 7 days before surgery. Ongoing research suggests that statins may reduce the risk of AF through pleiotropic effects independent of cholesterol lowering such as reductions in inflammation, oxidative damage, neurohormonal activation, and thrombosis. CONCLUSIONS: While the current evidence evaluating the use of statins to prevent POAF is encouraging, definitive conclusions cannot be drawn. However, because statins are widely used in cardiac patients for other indications and are not associated with the risks inherent to antiarrhythmic drugs, their value as an adjunct to current preventive strategies for POAF deserves further study. Additional research is needed to examine the effectiveness of statins in risk-stratified patients undergoing CABG surgery and the impact on patient outcomes and attributed costs.
OBJECTIVE: To review the published literature evaluating the effectiveness of statin therapy for preventing postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery. DATA SOURCES: A MEDLINE search was performed (1950-October 2007) using the search terms statins, HMG-CoA reductase inhibitors, coronary artery bypass graft, cardiac surgery, and atrial fibrillation. STUDY SELECTION AND DATA EXTRACTION: All articles published in English describing or evaluating the use of statins in humans to prevent atrial fibrillation (AF) were included. Additional pertinent articles were identified from reference lists. DATA SYNTHESIS: POAF is a common complication following CABG surgery that is associated with significant morbidity. Current preventive strategies include the use of beta-blockers and antiarrhythmic drugs such as amiodarone and sotalol. Accumulating evidence suggests that statins may also reduce the risk of POAF. Numerous studies in nonsurgical cardiovascular patients have found reduced rates of AF with statins. In patients who have undergone CABG, several observational studies have also documented benefit. One randomized controlled trial reported a significant reduction in the risk of POAF and reduced length of hospital stay in patients given preoperative atorvastatin beginning 7 days before surgery. Ongoing research suggests that statins may reduce the risk of AF through pleiotropic effects independent of cholesterol lowering such as reductions in inflammation, oxidative damage, neurohormonal activation, and thrombosis. CONCLUSIONS: While the current evidence evaluating the use of statins to prevent POAF is encouraging, definitive conclusions cannot be drawn. However, because statins are widely used in cardiac patients for other indications and are not associated with the risks inherent to antiarrhythmic drugs, their value as an adjunct to current preventive strategies for POAF deserves further study. Additional research is needed to examine the effectiveness of statins in risk-stratified patients undergoing CABG surgery and the impact on patient outcomes and attributed costs.
Authors: Mohit K Turagam; Francis X Downey; David C Kress; Jasbir Sra; A Jamil Tajik; Arshad Jahangir Journal: Expert Rev Clin Pharmacol Date: 2015-03 Impact factor: 5.045
Authors: Angelo B Biviano; Tamim Nazif; Jose Dizon; Hasan Garan; Jessica Fleitman; Dua Hassan; Samir Kapadia; Vasilis Babaliaros; Ke Xu; Rupa Parvataneni; Josep Rodes-Cabau; Wilson Y Szeto; William F Fearon; Danny Dvir; Todd Dewey; Mathew Williams; Michael J Mack; John G Webb; D Craig Miller; Craig R Smith; Martin B Leon; Susheel Kodali Journal: Circ Cardiovasc Interv Date: 2016-01 Impact factor: 6.546
Authors: Ashraf A Sabe; Nassrene Y Elmadhun; Ahmed A Sadek; Louis M Chu; Cesario Bianchi; Frank W Sellke Journal: J Thorac Cardiovasc Surg Date: 2014-08-13 Impact factor: 5.209
Authors: Salima Mithani; Muhammad S Akbar; Deborah J Johnson; Michael Kuskowski; Katherine K Apple; Jana Bonawitz-Conlin; Herbert B Ward; Rosemary F Kelly; Edward O McFalls; Hanna E Bloomfield; Jian-Ming Li; Selcuk Adabag Journal: J Cardiothorac Surg Date: 2009-11-04 Impact factor: 1.637