Daily Dose: Statin Effects in AF-related Stroke

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On April 18, 2023, we reported on a study abstract presented at the European Heart Rhythm Association 2023 that examined the association between statin use and the incidence of stroke and transient ischemic attack (TIA) in patients with atrial fibrillation (AF).

The study

Researchers used the Hong Kong Clinical Data Analysis and Reporting System to identify all patients with a new diagnosis of AF between 2010 and 2018. Participants were divided into 2 groups: statin users, who had received statins for at least 90 consecutive days during the year after diagnosis, and nonusers.

The primary outcomes were the combined endpoint of ischemic stroke or systemic embolism; hemorrhagic stroke; and TIA. The study included a total of 51 472 patients with AF (median age, 75 years; 48% women), of which 11 866 were classified as statin users and 39 606 were nonusers.

The findings

During a median follow up of 5 years, statin users had a significantly lower risk of all primary outcomes compared to nonusers. Investigators observed that statin use was associated with a 17% decreased risk of ischemic stroke or systemic embolism (hazard ratio [HR] 0.83, 95% CI 0.78–0.89), a 7% decreased risk of hemorrhagic stroke (HR 0.93, 95% CI 0.89–0.98), and a 15% reduced risk of TIA (HR 0.85, 95% CI 0.80–0.90).

Compared to participants that used statins for between 3 months and 2 years, those using statins for ≥6 years had a 43% lower risk of ischemic stroke or systemic embolism (HR 0.57, 95% CI 0.54–0.61), 44% reduced likelihood of hemorrhagic stroke (HR 0.56, 95% CI 0.53–0.60), and 42% reduced risk of TIA (HR 0.58, 95% CI 0.52–0.64). These associations were consistent regardless of whether patients with AF used anticoagulant drugs and the type of anticoagulant.

Note from author

"These data support the use of statins to prevent stroke and transient ischaemic attack in patients with new-onset atrial fibrillation. The findings have important clinical implications particularly given that in atrial fibrillation patients, ischaemic strokes are often fatal or disabling, and have a high risk of recurrence."

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