New Data Support Use of Statins in Patients with New-onset Atrial Fibrillation to Prevent Stroke, Transient Ischemic Attack

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New research shows that patients with atrial fibrillation (AF) who started statins within a year of diagnosis had reduced risks of stroke and transient ischemic attack (TIA) compared with those who did not start statins.

Results showed that statin use was associated with a 17% decreased risk of ischemic stroke or systemic embolism and a 15% reduced risk of TIA.

Findings were presented at the European Heart Rhythm Association (EHRA) 2023, a scientific congress of the European Society of Cardiology (ESC), held April 16-18, 2023, in Barcelona, Spain.

“Our study indicates that taking statins for many years was even more protective against stroke than short-term use,” said presenting author Jiayi Huang, PhD student, University of Hong Kong, China, in an ESC press release.

Persons with AF have a 5-times greater risk of stroke than those without AF, according to the press release. Although anticoagulant medication is recommended to prevent strokes in patients with AF, it does not eliminate the risk of stroke completely in this patient population. Statin therapy is prescribed to reduce cholesterol and the likelihood of myocardial infarction and stroke, however, the benefit of statins for prevention of stroke in patients with AF is unclear.

To examine the association between statin use and the incidence of stroke and TIA in patients with AF, Huang and colleagues 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. Patients were followed until the occurrence of the primary outcomes, death, or the end of the study on October 31, 2022.

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.

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).

In addition, long-term statin use was associated with greater protection than short-term use, according to the press release. 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.

“These data support the use of statins to prevent stroke and transient ischaemic attack in patients with new-onset atrial fibrillation,” added Huang. “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.”

Huang presented the abstract “Statin use improves the outcomes in patients with atrial fibrillation: A population-based study” during the session Atrial Fibrillation – Round 1 – Stroke – OAC on April 16, 2023, at 9:40 CEST.