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  • Review Article
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Statins and polyunsaturated fatty acids for treatment of atrial fibrillation

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 30–41 (2008)Cite this article

Abstract

Atrial fibrillation (AF) affects 1.5–2.0% of the population in the developed world. Projected data from population-based studies in the US indicate that the number of adults with AF will swell by 2.5–3.0-fold by 2050. Despite advances in pharmacological and nonpharmacological therapies for rhythm or rate control in patients with AF, primary prevention with 'upstream' therapy and risk factor modification is likely to produce a far greater effect in the general population than specific interventions. Rapidly developing experimental work has provided new insights into AF pathophysiology that will lead to new mechanism-based therapies. Agents targeting inflammation, oxidative injury, atrial myocyte metabolism, extracellular matrix remodeling, and fibrosis, have theoretical advantages as novel therapeutic strategies. Angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, β-blockers, statins, and omega-3 polyunsaturated fatty acids have shown antiarrhythmic potential, over and above any effect related to the treatment of underlying heart disease. These agents could be exploited to prevent or delay atrial remodeling in patients with AF, even in the absence of routine indications for such therapy. This Review provides a contemporary evidence-based insight into the possible preventive and reverse remodeling roles of statins and polyunsaturated fatty acids in AF.

Key Points

  • The high lifetime risk for atrial fibrillation (AF) and increased incidence with longevity underscore the important public-health burden posed by AF

  • Specific interventions for rhythm or rate control are modestly effective in some patients, but are not consistently applied to all those at risk of AF because of adverse effects, limited availability and increased costs

  • Recently, atrial stretch, angiotensin II and inflammation have been recognized as key elements in atrial remodeling and the formation of the substrate for AF

  • Experimental studies using rapid atrial pacing, sterile pericarditis and heart failure models of AF have convincingly demonstrated that treatment with renin–angiotensin system antagonists, statins and specific anti-inflammatory agents, such as corticosteroids, reduces the amount of atrial fibrosis and counteracts changes in electrical properties of the atrial myocardium associated with sustained AF

  • A raft of therapies with 'upstream' effects are now being actively investigated and results are promising so far; the antiarrhythmic potential of statins and polyunsaturated fatty acids probably goes beyond any effect related to the treatment of underlying heart disease

  • It is highly likely that the clinical approach to AF management in the general population will change substantially in the near future

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Figure 1: Pathophysiological processes associated with atrial remodeling that could be targets potentially modifiable by statins and n-3 polyunsaturated fatty acids, and summary of the evidence of their clinical use in the prevention of atrial fibrillation.
Figure 2: Risk of atrial fibrillation in the highest versus lowest fish-consumption groups, as reported in several population-based studies.

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Authors and Affiliations

  1. I Savelieva is a Clinical Lecturer in Cardiology, and J Camm is Professor of Clinical Cardiology, at St George's University of London, London, UK.,

    Irina Savelieva & John Camm

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  1. Irina Savelieva
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Correspondence to John Camm.

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Savelieva, I., Camm, J. Statins and polyunsaturated fatty acids for treatment of atrial fibrillation. Nat Rev Cardiol 5, 30–41 (2008). https://doi.org/10.1038/ncpcardio1038

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