Document Detail


Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial).
MedLine Citation:
PMID:  20946227     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Inflammation and oxidative stress are associated with atrial fibrillation (AF). Statins have antioxidant and anti-inflammatory properties. We tested if atorvastatin reduced AF recurrence after DC cardioversion (CV) by modifying systemic oxidative stress and inflammation (NCT00252967).
METHODS AND RESULTS: In a randomized, double-blinded, placebo-controlled trial, patients with atrial fibrillation/flutter (AF) were randomized to receive either atorvastatin 80 mg (n = 33) or placebo (n = 31) before CV. Treatment was continued for 12 months or until AF recurred. Serum oxidative stress markers (ratios of oxidized to reduced glutathione and cysteine, derivatives of reactive oxygen species, isoprostanes) and inflammatory markers (high-sensitivity C- reactive protein [hs-CRP], interleukin-6 [IL-6], interleukin-1β[IL-1β], tumor necrosis factor alpha [TNFα]) were measured at baseline and on follow-up. AF recurred in 22 (66.7%) of atorvastatin and 26 (83.9%) of placebo group (P = 0.2). The adjusted hazard ratio of having recurrence on atorvastatin versus on placebo was 0.99 (95% CI: 0.98-1.01, P = 0.3). There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates (median [IR]: 29 [2-145] days versus 22 [7-70] days, P = 0.9). Although no significant effect was seen on oxidative stress, 2 of 4 inflammatory markers, IL-6 (adjusted OR: 0.59, 95% CI: 0.35-0.97, P = 0.04) and hs-CRP (adjusted OR: 0.59, 95% CI: 0.37-0.95, P = 0.03) were significantly lowered with atorvastatin. Cholesterol levels significantly decreased with atorvastatin (P = 0.03).
CONCLUSIONS: High-dose atorvastatin did not reduce the recurrence of AF after CV. It reduced selective markers of inflammation without affecting systemic oxidative stress. Failure of atorvastatin to prevent AF recurrence may be due to its failure to affect oxidative stress.
Authors:
Smita Negi; Irfan Shukrullah; Emir Veledar; Heather L Bloom; Dean P Jones; Samuel C Dudley
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-10-13
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  22     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-14     Completed Date:  2012-03-06     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  414-9     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Affiliation:
Section of Cardiology, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00252967
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / blood*,  etiology,  prevention & control*
Biological Markers / blood
Double-Blind Method
Electric Countershock / adverse effects,  methods
Female
Follow-Up Studies
Heptanoic Acids / therapeutic use*
Humans
Inflammation Mediators / blood
Male
Middle Aged
Oxidative Stress / physiology
Pyrroles / therapeutic use*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
P01 HL058000/HL/NHLBI NIH HHS; P01 HL058000-11A15167/HL/NHLBI NIH HHS; R01 HL073753/HL/NHLBI NIH HHS; R01 HL085558/HL/NHLBI NIH HHS; R01 HL085558-01A1/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Heptanoic Acids; 0/Inflammation Mediators; 0/Pyrroles; A0JWA85V8F/atorvastatin
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2011 Apr;22(4):420-1   [PMID:  21091967 ]

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