Chia-Hsuin Chang1, Yen-Chieh Lee2, Chia-Ti Tsai3, Sheng-Nan Chang4, Yu-Heng Chung2, Min-Shung Lin5, Jou-Wei Lin6, Mei-Shu Lai7. 1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. 2. Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan. 3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. 4. Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan. 5. Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan. 6. Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan. Electronic address: jouweilin@yahoo.com. 7. Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: To contain cost, Taiwan's previous National Health Insurance Reimbursement Policy requested that physicians discontinue their patients' statin therapy once the serum cholesterol had reached appropriate levels. This allowed us to evaluate the association between statin continuation and the occurrence of atrial fibrillation/flutter and whether it was modified by chronic kidney disease (CKD) status. METHODS: Patients who initiated statin therapy between January 1, 2001 and December 31, 2009 were identified from a random sample of one million subjects in the Taiwan National Health Insurance Research Database. The outcome was atrial fibrillation/flutter. A proportional hazard regression model with time-varying statin use was applied to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) for atrial fibrillation/flutter according to current statin use versus treatment discontinuation, adjusted for baseline disease risk scores and time-varying covariates. RESULTS: A total of 6767 CKD and 63,678 non-CKD patients initiating statin therapy were included and followed for an average of 4.0 years. A total of 1118 participants experienced new-onset atrial fibrillation/flutter. The incidence of atrial fibrillation/flutter was approximately 2 fold higher in the CKD patients. Continuation of statin therapy was associated with a 22% (adjusted hazard ratio 0.78; 95% CI: 0.65-0.93) and 57% (adjusted HR 0.43; 95% CI: 0.27-0.68) decrease in atrial fibrillation/flutter hazard as compared with discontinuation in non-CKD and CKD patients, respectively. CONCLUSIONS: Continuation of statin therapy was associated with a decreased risk of atrial fibrillation/flutter among CKD and non-CKD patients. However, further randomized studies are still needed to assess the association.
BACKGROUND: To contain cost, Taiwan's previous National Health Insurance Reimbursement Policy requested that physicians discontinue their patients' statin therapy once the serum cholesterol had reached appropriate levels. This allowed us to evaluate the association between statin continuation and the occurrence of atrial fibrillation/flutter and whether it was modified by chronic kidney disease (CKD) status. METHODS:Patients who initiated statin therapy between January 1, 2001 and December 31, 2009 were identified from a random sample of one million subjects in the Taiwan National Health Insurance Research Database. The outcome was atrial fibrillation/flutter. A proportional hazard regression model with time-varying statin use was applied to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) for atrial fibrillation/flutter according to current statin use versus treatment discontinuation, adjusted for baseline disease risk scores and time-varying covariates. RESULTS: A total of 6767 CKD and 63,678 non-CKDpatients initiating statin therapy were included and followed for an average of 4.0 years. A total of 1118 participants experienced new-onset atrial fibrillation/flutter. The incidence of atrial fibrillation/flutter was approximately 2 fold higher in the CKDpatients. Continuation of statin therapy was associated with a 22% (adjusted hazard ratio 0.78; 95% CI: 0.65-0.93) and 57% (adjusted HR 0.43; 95% CI: 0.27-0.68) decrease in atrial fibrillation/flutter hazard as compared with discontinuation in non-CKD and CKDpatients, respectively. CONCLUSIONS: Continuation of statin therapy was associated with a decreased risk of atrial fibrillation/flutter among CKD and non-CKDpatients. However, further randomized studies are still needed to assess the association.