Hey – one more stuck in my outbox.
Nobody wants to take medications they don’t have to. Many of my patients are especially concerned about taking statins (cholesterol meds like Lipitor/atorvastatin or Crestor/rosuvastatin to name a couple) fearing side effects or other issues, not to mention whether or not it’s actually benefiting them. This is an active conversation with all of my folks, really regardless of what meds they might be taking.
Now a study came out supporting the idea that those with atrial fibrillation would benefit from taking a cholesterol lowering drug. How does that make sense?
One needs to understand that lowering cholesterol (mainly the large LDL portion) is only one thing that the HMG CoA Reductase Inhibitors (yeah, that’s really what a Statin is) does. That effect takes weeks. But it’s long been known that statins can have benefit within 3 days. Turns out that statins stabilize the blood vessel walls, making heart attacks are that much harder to happen. We take advantage of this fact in patients with Long COVID as well, since micro-clots seem to be at the heart of a lot of the LC problems and this activity keeps that process slowed.
As usual, the body does more than one thing with one process. That’s why drugs can be problematic, but sometimes those “side effects” can translate into a real “up” side – think Viagra 😉.
Statins Tied to Lower Stroke Risk in Atrial Fibrillation
Among patients with atrial fibrillation (AF), initiation of statins soon after diagnosis was protective against stroke and related vascular events, and longer duration of use was associated with greater protection, a new cohort study shows.
Statin use was associated with lower risks of ischemic stroke or systemic embolism, hemorrhagic stroke, and transient ischemic attack (TIA), regardless of whether patients were also taking anticoagulant medications.
Lead author Jiayi Huang, a PhD student at Hong Kong University at Shenzhen Hospital, Shenzhen, China, concluded that the study's findings support the use of statins to prevent stroke for patients with new-onset AF.
"The findings have important clinical implications, particularly given that in atrial fibrillation, patients' ischemic strokes are often fatal or disabling and have a high risk of recurrence," she said.
The results were presented in a moderated poster session at the European Heart Rhythm Association (EHRA) 2023 in Barcelona and are available online.
Widely Prescribed
Anticoagulant drugs are prescribed to lower the fivefold increased risk of stroke among individuals with AF compared with those without AF, but the therapy does not eliminate the higher risk, Huang explained. And although statins are widely prescribed to reduce the likelihood of myocardial infarction and stroke, "the benefit of statins for stroke prevention in patients with atrial fibrillation has been unclear," she said.
Huang and colleagues analyzed data from 51,472 patients newly diagnosed with AF between 2010 and 2018. The population was divided into statin users (n = 11,866), defined as patients who had taken statins for at least 19 consecutive days in the first year after AF diagnosis, and statin nonusers (n = 39,606), based on whether they were prescribed statin therapy after their first diagnosis of AF.
The median age of the cohort was 74.9 years, and 47.7% were women. The investigators used statistical methods to balance baseline covariates between the two groups.
The primary outcomes were ischemic stroke or systemic embolism, hemorrhagic stroke, and TIA. Median follow-up was 5.1 years.
Statin use was associated with a significantly lower risk of all outcomes compared with nonuse. Statin users had a 17% reduced risk of ischemic stroke or systemic embolism, a 7% reduced risk of hemorrhagic stroke, and a 15% rate of reduced risk of TIA, Huang reported.