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Professor and Vice Chair, Department of Pharmacy Practice, School of Pharmacy, University of Kansas Medical Center, Kansas City, KS
Assistant Professor, Department of Pharmacy Practice, School of Pharmacy, University of Kansas
Reprints: Dr. Howard, University of Kansas Medical Center, Department of Pharmacy Practice, Room B440 Mailstop 4047, 3901 Rainbow Blvd., Kansas City, KS 66160, fax 913/588-2355, phoward{at}kumc.edu
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 β-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.
Key Words: atrial fibrillation, coronary artery bypass graft surgery, statins
Published Online, January 15, 2008. www.theannals.com, DOI 10.1345/aph.1K590
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