Homa Nomani1, Amir Hooshang Mohammadpour2,3, Željko Reiner4, Tannaz Jamialahmadi5,6, Amirhossein Sahebkar7,8,9. 1. School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9179156314, Iran. 2. Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9179156314, Iran. 3. Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9179156314, Iran. 4. Department of Internal Medicine, University Hospital Ceter Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia. 5. Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan 9479176135, Iran. 6. Department of Nutrition, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran. 7. Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran. 8. Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran. 9. Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland.
Abstract
BACKGROUND: Atrial fibrillation (AF) occurring after cardiac surgery, post-operative AF (POAF), is a serious and common complication of this treatment. POAF may be life-threatening and the available preventive strategies are insufficient or are associated with significantly increased risk of adverse effects, especially in long-term use. Therefore, more appropriate treatment strategies are needed. METHODS: In this paper, the efficacy, safety, and other aspects of using statins in the prevention of POAF focusing on their anti-inflammatory effects are reviewed. RESULTS: Recent studies have suggested that inflammation has a significant role in POAF, from the first AF episode to its serious complications including stroke and peripheral embolism. On the other hand, statins, the most widely used medications in cardiovascular patients, have pleiotropic effects, including anti-inflammatory properties. Therefore, they may potentially be effective in POAF prevention. Statins, especially atorvastatin, appear to be an effective option for primary prevention of POAF, especially in patients who had coronary artery bypass grafting (CABG), a cardiac surgery treatment associated with inflammation in the heart muscle. However, several large studies, particularly with rosuvastatin, did not confirm the beneficial effect of statins on POAF. One large clinical trial reported higher risk of acute kidney injury (AKI) following high-dose rosuvastatin in Chinese population. In this study, rosuvastatin reduced the level of C-reactive protein (CRP) but did not reduce the rate of POAF. CONCLUSION: Further studies are required to find the most effective statin regimen for POAF prevention with the least safety concern and the highest health benefits.
BACKGROUND:Atrial fibrillation (AF) occurring after cardiac surgery, post-operative AF (POAF), is a serious and common complication of this treatment. POAF may be life-threatening and the available preventive strategies are insufficient or are associated with significantly increased risk of adverse effects, especially in long-term use. Therefore, more appropriate treatment strategies are needed. METHODS: In this paper, the efficacy, safety, and other aspects of using statins in the prevention of POAF focusing on their anti-inflammatory effects are reviewed. RESULTS: Recent studies have suggested that inflammation has a significant role in POAF, from the first AF episode to its serious complications including stroke and peripheral embolism. On the other hand, statins, the most widely used medications in cardiovascular patients, have pleiotropic effects, including anti-inflammatory properties. Therefore, they may potentially be effective in POAF prevention. Statins, especially atorvastatin, appear to be an effective option for primary prevention of POAF, especially in patients who had coronary artery bypass grafting (CABG), a cardiac surgery treatment associated with inflammation in the heart muscle. However, several large studies, particularly with rosuvastatin, did not confirm the beneficial effect of statins on POAF. One large clinical trial reported higher risk of acute kidney injury (AKI) following high-dose rosuvastatin in Chinese population. In this study, rosuvastatin reduced the level of C-reactive protein (CRP) but did not reduce the rate of POAF. CONCLUSION: Further studies are required to find the most effective statin regimen for POAF prevention with the least safety concern and the highest health benefits.
Authors: Amirhossein Sahebkar; Corina Serban; Sorin Ursoniu; Dimitri P Mikhailidis; Anetta Undas; Gregory Y H Lip; Vera Bittner; Kausik Ray; Gerald F Watts; G Kees Hovingh; Jacek Rysz; John J P Kastelein; Maciej Banach Journal: Thromb Haemost Date: 2015-12-03 Impact factor: 5.249
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