More than 50,000 patients with atrial fibrillation experienced reduced risks of stroke if they started statins within a year of diagnosis, compared with those who did not.
New research from a region-wide study found statin use was associated with reduced risk of stroke and transient ischemic attack in patients with atrial fibrillation.1
The findings, presented in a late-breaking science session at the European Heart Rhythm Association (EHRA) 2023 meeting in Barcelona, Spain, showed that risks were reduced in those who started statins within a year of diagnosis, compared with those that did not.
“Our study indicates that taking statins for many years was even more protective against stroke than short-term use,” said study author Jiayi Huang, a PhD student at the University of Hong Kong.
More than 40 million people globally are affected by atrial fibrillation and patients with the condition experience a 5-times greater risk of stroke than their peers. Although anticoagulants are recommended to prevent strokes in patients with atrial fibrillation, it does not completely eliminate risk. Statin therapy is widely prescribed to lower blood cholesterol and reduce the likelihood of heart attack and stroke, but the benefits are unclear for stroke prevention in those with atrial fibrillation.
Using the Hong Kong Clinical Data Analysis and Reporting System, the current study investigated the association between statin use and the incidence of stroke in patients with atrial fibrillation. Huang and colleagues identified all patients with a new diagnosis of atrial fibrillation between 2010 and 2018. The team divided patients into statin users and non-users, with users having received statins for at least 90 consecutive days during the year after being diagnosed with atrial fibrillation.
Primary outcomes for the study included a combined endpoint of ischemic stroke of systemic embolism, hemorrhagic stroke, and transient ischemic attack. A total of 51,472 patients (median age, 75 years; 48% women. with a new diagnosis of atrial fibrillation were included, of which 11,866 were classified as statin users and 39,606 as non-users. All patients were followed up with until the occurrence of the primary outcomes, death, or the end of the study in October 2022.
Over a median follow-up of 5 years, investigators found statin users had a significantly lower risk of all primary outcomes compared to non-users. The analysis showed statin use was associated with a 17% reduced risk of ischemic stroke or systemic embolism (hazard ratio [HR], 0.83; 95% CI, 0.78 - 0.89), a 7% reduced risk of hemorrhagic stroke (HR, 0.93; 95% CI, 0.89 - 0.98), and a 15% reduced risk of transient ischemic attack (HR, 0.85; 95% CI, 0.80 - 0.90).
According to the analysis, long-term statin use was associated with greater protection than short-term use. When compared to patients taking medication 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 transient ischemic attack (HR, 0.58; 95% CI, 0.52 - 0.64).
Investigators noted the associations were consistent, regardless of whether an anticoagulant medication was used, as well as the type of anticoagulant used if so. Based on the findings, Huang noted the data support the use of statins to prevent stroke and transient ischemic attack in patients with new-onset atrial fibrillation.
“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,” Huang said”