Statin use improves the outcomes in patients with atrial fibrillation: A population-based study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sanmin project, Shenzhen, China Background There is inconclusive evidence regarding the impact of statins on the risk of atrial fibrillation (AF) related outcomes. The current study investigated whether statin use would improve outcomes among patients with non-valvular AF. Purpose To assess the association between statin use and AF-related outcomes among patients with AF. Methods Patients newly diagnosed with AF (n = 51,472) between 2010-2018 were divided into statin users (n =11,866) and statin nonusers (n =39,606), according to whether they received statin therapy after their first diagnosis of AF. The primary outcomes included ischaemic stroke (IS) and systemic embolism (SE), haemorrhagic stroke (HS), and transient ischaemic attack (TIA). An inverse probability of treatment weighting was used to balance baseline covariates between the two groups. The Fine and Grey competing risks model was applied, with death defined as the competing event. Results The median age of the cohort was 74.9 years, and 47.7% were female. During the median follow-up of 5.1 years, previous statin use was significantly associated with a lower risk of IS/SE compared with statin nonusers (subdistribution hazard ratio [SHR] = 0.83, 95%CI: 0.78-0.89). Similar patterns were found in the association between previous statin use and HS (SHR = 0.93, 95%CI: 0.89-0.98) and TIA (SHR = 0.85, 95%CI: 0.80-0.90, P <0.01). Moreover, ≥6 years of statin use predicted a lower risk of IS/SE, HS and TIA (IS/SE: SHR = 0.57, 95%CI: 0.54-0.61; HS: SHR = 0.56, 95%CI: 0.53-0.60; TIA: SHR = 0.58, 95%CI: 0.52-0.64) compared to those with short-term (3 months to <2 years) statin use. Stratified analyses demonstrated that the lower risk of IS associated with statin use was consistent. Conclusion Statin use was associated with a lower risk of incident IS/SE, HS and TIA in a duration-dependent manner among AF patients.