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Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study

BACKGROUND: Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF. MET...

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Autores principales: Shweikialrefaee, Bisan, Ko, Dennis T., Fang, Jiming, Pang, Andrea, Austin, Peter C., Dorian, Paul, Singh, Sheldon M., Jackevicius, Cynthia A., Tu, Karen, Lee, Douglas S., Abdel‐Qadir, Husam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356038/
https://www.ncbi.nlm.nih.gov/pubmed/37318025
http://dx.doi.org/10.1161/JAHA.122.028381
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author Shweikialrefaee, Bisan
Ko, Dennis T.
Fang, Jiming
Pang, Andrea
Austin, Peter C.
Dorian, Paul
Singh, Sheldon M.
Jackevicius, Cynthia A.
Tu, Karen
Lee, Douglas S.
Abdel‐Qadir, Husam
author_facet Shweikialrefaee, Bisan
Ko, Dennis T.
Fang, Jiming
Pang, Andrea
Austin, Peter C.
Dorian, Paul
Singh, Sheldon M.
Jackevicius, Cynthia A.
Tu, Karen
Lee, Douglas S.
Abdel‐Qadir, Husam
author_sort Shweikialrefaee, Bisan
collection PubMed
description BACKGROUND: Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF. METHODS AND RESULTS: Using linked administrative databases in Ontario, Canada, we conducted a population‐based retrospective cohort study of patients, aged ≥66 years, diagnosed with AF between 2009 and 2019. We used cause‐specific hazard regression to determine the association of statin use with stroke rate. We developed a second model to further adjust for lipid levels in the subset of patients with available measurements in the year before AF diagnosis. Both models adjusted for age, sex, heart failure, hypertension, diabetes, stroke/transient ischemic attack, vascular disease, and P2Y12 inhibitors at baseline, plus anticoagulation as a time‐varying covariate. We studied 261 659 qualifying patients (median age, 78 years; 49% women). Statins were used in 142 834 (54.6%) patients, and 145 673 (55.7%) had lipid measurement(s) in the preceding year. Statin use was associated with lower stroke rates, with adjusted hazard ratios of 0.83 (95% CI, 0.77–0.88; P<0.001) in the full cohort and 0.87 (95% CI, 0.78–0.97; P=0.01) when adjusting for lipid data. Stroke rates increased in a near‐linear manner as low‐density lipoprotein values increased >1.5 mmol/L. CONCLUSIONS: Statins were associated with lower stroke rates in patients with AF, whereas higher low‐density lipoprotein levels were associated with higher stroke rates, highlighting the importance of vascular risk factor treatment in AF.
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spelling pubmed-103560382023-07-20 Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study Shweikialrefaee, Bisan Ko, Dennis T. Fang, Jiming Pang, Andrea Austin, Peter C. Dorian, Paul Singh, Sheldon M. Jackevicius, Cynthia A. Tu, Karen Lee, Douglas S. Abdel‐Qadir, Husam J Am Heart Assoc Original Research BACKGROUND: Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF. METHODS AND RESULTS: Using linked administrative databases in Ontario, Canada, we conducted a population‐based retrospective cohort study of patients, aged ≥66 years, diagnosed with AF between 2009 and 2019. We used cause‐specific hazard regression to determine the association of statin use with stroke rate. We developed a second model to further adjust for lipid levels in the subset of patients with available measurements in the year before AF diagnosis. Both models adjusted for age, sex, heart failure, hypertension, diabetes, stroke/transient ischemic attack, vascular disease, and P2Y12 inhibitors at baseline, plus anticoagulation as a time‐varying covariate. We studied 261 659 qualifying patients (median age, 78 years; 49% women). Statins were used in 142 834 (54.6%) patients, and 145 673 (55.7%) had lipid measurement(s) in the preceding year. Statin use was associated with lower stroke rates, with adjusted hazard ratios of 0.83 (95% CI, 0.77–0.88; P<0.001) in the full cohort and 0.87 (95% CI, 0.78–0.97; P=0.01) when adjusting for lipid data. Stroke rates increased in a near‐linear manner as low‐density lipoprotein values increased >1.5 mmol/L. CONCLUSIONS: Statins were associated with lower stroke rates in patients with AF, whereas higher low‐density lipoprotein levels were associated with higher stroke rates, highlighting the importance of vascular risk factor treatment in AF. John Wiley and Sons Inc. 2023-06-15 /pmc/articles/PMC10356038/ /pubmed/37318025 http://dx.doi.org/10.1161/JAHA.122.028381 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Shweikialrefaee, Bisan
Ko, Dennis T.
Fang, Jiming
Pang, Andrea
Austin, Peter C.
Dorian, Paul
Singh, Sheldon M.
Jackevicius, Cynthia A.
Tu, Karen
Lee, Douglas S.
Abdel‐Qadir, Husam
Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
title Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
title_full Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
title_fullStr Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
title_full_unstemmed Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
title_short Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
title_sort statin use and stroke rate in older adults with atrial fibrillation: a population‐based cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356038/
https://www.ncbi.nlm.nih.gov/pubmed/37318025
http://dx.doi.org/10.1161/JAHA.122.028381
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