Statins, inflammation, oxidative stress, and atrial fibrillation.

In this issue of the Journal, Negi et al.1 reported their study investigating whether or not high-dose atorvastatin could reduce atrial fibrillation (AF) recurrence after electrical cardioversion (EC) by modifying systemic oxidative stress and inflammation. They concluded that while high-dose atorvastatin could reduce selective markers of inflammation, it did not affect systemic oxidative stress and did not prevent the recurrence of AF post-EC. Ironically, the “SToP AF trial” of Negi et al.1 failed to stop AF recurrence! Their results may not be surprising because the AF guideline from the European Society of Cardiology recommends that upstream therapies with statins are not recommended for primary prevention of AF in patients without cardiovascular disease.2 Rather, statin therapy should be considered for prevention of new-onset AF after coronary artery bypass grafting, isolated or in combination with valvular interventions, and patients with underlying heart disease, particularly heart failure.2 AF is the most frequently encountered sustained arrhythmia occurring in 1-2% of the general population; it can increase the risk of stroke, thromboembolic events, heart failure, rates of death, and is an independent predictor of mortality.2 Antiarrhythmic drugs plus anticoagulation treatment is currently the first-line therapy in patients with symptomatic AF. However, current pharmacological treatments have limited therapeutic efficacy. Radiofrequency atrial ablation is often adopted with high success rate in patients with AF to restore their sinus rhythm.3 Recently, attentions have been paid to the upstream therapy including statins, because systemic and cardiac inflammation and related oxidative stress are associated with the initiation and maintenance of some forms of AF.4 Since statins have both antioxidant and antiinflammatory properties, several studies have been conducted to test their efficacy in the treatment and prevention of AF. Unfortunately, the results are conflicting and confusing. In a retrospective study, the use of simvastatin or atorvastatin was shown to be associated with a significant decrease in the risk of arrhythmia recurrence after successful EC in patients with lone AF.5 Atorvastatin has been demonstrated to significantly decrease the recurrence rate of AF after successful EC,6 and statin therapy can have benefits on the recurrence rates of AF after EC in patients with a significant prevalence of coronary artery disease.7 Furthermore, there is some evidence of a