title: Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial). Effects of rosuvastatin on atrial fibrillation occurrence: ancillary results of the GISSI-HF trial. Publication bias and clinical trials. A multicenter risk index for atrial fibrillation after cardiac surgery. Effect of Intensive Versus Standard Lipid-Lowering Treatment With Atorvastatin on the Progression of Calcified Coronary Atherosclerosis Over 12 Months: A Multicenter, Randomized, Double-Blind Trial Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study Simvastatin Lowers C-Reactive Protein Within 14 Days: An Effect Independent of Low-Density Lipoprotein Cholesterol Reduction Effects of rosuvastatin on asymmetric dimethylarginine levels and early atrial fibrillation recurrence after electrical cardioversion. Atorvastatin prevents atrial fibrillation in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker: a prospective randomized trial. Effects of Preoperative Short Term Use of Atorvastatin on Endothelial Progenitor Cells after Coronary Surgery: A Randomized, Controlled Trial The incidence and risk factors for new onset atrial fibrillation in the PROSPER study. Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting. Atorvastatin Increases the Number of Endothelial Progenitor Cells After Cardiac Surgery: A Randomized Control Study Effect of lipid lowering on new-onset atrial fibrillation in patients with asymptomatic aortic stenosis: the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial. Atorvastatin Given prior to Electrical Cardioversion Does Not Affect the Recurrence of Atrial Fibrillation in Patients with Persistent Atrial Fibrillation Who Are on Antiarrhythmic Therapy Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting. Effect of statin dose on incidence of atrial fibrillation: data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) and Aggrastat to Zocor (A to Z) trials. Pravastatin immunomodulates IL-6 and C-reactive protein, but not IL-1 and TNF-alpha, in cardio-pulmonary bypass. Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. Effect of C-reactive protein reduction on paroxysmal atrial fibrillation. Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study. The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. High-dose atorvastatin and risk of atrial fibrillation in patients with prior stroke or transient ischemic attack: analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Effects of simvastatin on systemic inflammatory responses after cardiopulmonary bypass. Analysis of pravastatin to prevent recurrence of atrial fibrillation after electrical cardioversion. High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Effect of atorvastatin on the recurrence rates of atrial fibrillation after electrical cardioversion. Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery
abstract: 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 r and omized , double-blinded , placebo-controlled trial , patients with atrial fibrillation/flutter ( AF ) were r and omized 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 AIMS This ancillary analysis of the GISSI-HF data base aims at assessing the effect of rosuvastatin on the occurrence of  atrial fibrillation ( AF )  in patients with chronic heart failure ( HF ) who were not in AF at study entry . METHODS AND RESULTS GISSI-HF was a double-blind , placebo-controlled trial testing n-3 PUFA and rosuvastatin vs. corresponding placebos in patients with chronic HF .  Atrial fibrillation occurrence was defined as the presence of AF in the electrocardiogram ( ECG ) performed at each visit during the trial or AF as a cause of worsening HF or hospital admission or as an event during hospitalization . Among the 3690 patients ( 80.7 % ) without AF on their baseline ECG , 15.0 % developed AF during a median follow-up period of 3.7 years , 258 r and omized to rosuvastatin ( 13.9 % ) vs. 294 allocated to placebo ( 16.0 % ) . Although the difference was not significant at unadjusted analysis ( P = 0.097 ) and multivariable analysis adjusting for clinical variables ( P = 0.067 ) , it became significant after adjustment for clinical variables and laboratory examinations ( P = 0.039 ) , and for clinical variables , laboratory examinations , and background therapies ( P = 0.038 ) . CONCLUSION This study shows that there is some evidence of a beneficial effect of rosuvastatin in terms of reduction of AF occurrence in patients with HF . Larger population s are needed to provide a definite answer to the question . Clinical Trials.gov Identifier : NCT00336336 A study was performed to evaluate the extent to which the medical literature may be misleading as a result of selective publication of r and omized clinical trials ( RCTs ) with results showing a statistically significant treatment effect . Three hundred eighteen authors of published trials were asked whether they had participated in any unpublished RCTs .  The 156 respondents reported 271 unpublished and 1041 published trials . Of the 178 completed unpublished RCTs with a trend specified , 26 ( 14 % ) favored the new therapy compared to 423 of 767 ( 55 % ) published reports ( p less than 0.001 ) . For trials that were completed but not published , the major reasons for nonpublication were " negative " results and lack of interest . From the data provided , it appears that nonpublication was primarily a result of failure to write up and su bmi t the trial results rather than rejection of su bmi tted manuscripts . The results of this study imply the existence of a publication bias of importance both to meta- analysis and the interpretation of statistically significant positive trials CONTEXT Atrial fibrillation is a common , but potentially preventable , complication following coronary artery bypass graft ( CABG ) surgery . OBJECTIVES To assess the nature and consequences of atrial fibrillation after CABG surgery and to develop a comprehensive risk index that can better identify patients at risk for atrial fibrillation . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study of 4657 patients undergoing CABG surgery between November 1996 and June 2000 at 70 centers located within 17 countries , selected using a systematic sampling technique . From a derivation cohort of 3093 patients , associations between predictor variables and postoperative atrial fibrillation were identified to develop a risk model , which was assessed in a validation cohort of 1564 patients . MAIN OUTCOME MEASURE New-onset atrial fibrillation after CABG surgery . RESULTS A total of 1503 patients ( 32.3 % ) developed atrial fibrillation after CABG surgery . Postoperative atrial fibrillation was associated with subsequent greater re source use as well as with cognitive changes , renal dysfunction , and infection . Among patients in the derivation cohort , risk factors associated with atrial fibrillation were advanced age ( odds ratio [ OR ] for 10-year increase , 1.75 ; 95 % confidence interval [ CI ] , 1.59 - 1.93 ) ; history of atrial fibrillation ( OR , 2.11 ; 95 % CI , 1.57 - 2.85 ) or chronic obstructive pulmonary disease ( OR , 1.43 ; 95 % CI , 1.09 - 1.87 ) ; valve surgery ( OR , 1.74 ; 95 % CI , 1.31 - 2.32 ) ; and postoperative withdrawal of a beta-blocker ( OR , 1.91 ; 95 % CI , 1.52 - 2.40 ) or an angiotensin-converting enzyme ( ACE ) inhibitor ( OR 1.69 ; 95 % CI , 1.38 - 2.08 ) . Conversely , reduced risk was associated with postoperative administration of beta-blockers ( OR , 0.32 ; 95 % CI , 0.22 - 0.46 ) , ACE inhibitors ( OR , 0.62 ; 95 % CI , 0.48 - 0.79 ) , potassium supplementation ( OR , 0.53 ; 95 % CI , 0.42 - 0.68 ) , and nonsteroidal anti-inflammatory drugs ( OR , 0.49 ; 95 % CI , 0.40 - 0.60 ) . The result ing multivariable risk index had adequate discriminative power with an area under the receiver operating characteristic ( ROC ) curve of 0.77 in the validation sample . Forty-three percent ( 640/1503 ) of patients who had atrial fibrillation after CABG surgery experienced more than 1 episode of atrial fibrillation . Predictors of recurrent atrial fibrillation included older age , history of congestive heart failure , left ventricular hypertrophy , aortic atherosclerosis , bicaval venous cannulation , withdrawal of ACE inhibitor or beta-blocker therapy , and use of amiodarone or digoxin ( area under the ROC curve of 0.66 ) . Patients with recurrent atrial fibrillation had longer hospital stays and experienced greater infectious , renal , and neurological complications than those with a single episode . CONCLUSIONS We have developed and vali date d models predicting the occurrence of atrial fibrillation  after CABG surgery based on an analysis of a large multicenter international cohort . Our findings suggest that treatment with beta-blockers , ACE inhibitors , and /or nonsteroidal anti-inflammatory drugs may offer protection . Atrial fibrillation after CABG surgery is associated with important complications Background — Recent clinical trials have suggested that intensive versus st and ard lipid-lowering therapy provides for additional benefit . Electron-beam computed tomography provides the opportunity to quantify the progression of coronary artery calcification ( CAC ) in serial measurements . Methods and Results — In a multicenter , r and omized , double-blind trial , 471 patients ( age 61±8 years ) who had no history of coronary artery disease and no evidence of high- grade coronary stenoses ( > 50 % diameter reduction ) were r and omized if they had ≥2 cardiovascular risk factors and moderate calcified coronary atherosclerosis as evidence d by a CAC score ≥30 . Patients were assigned to receive 80 mg or 10 mg of atorvastatin per day over 12 months . Progression of CAC volume scores could be analyzed in 366 patients . After pretreatment with 10 mg of atorvastatin for 4 weeks , 12 months of study medication reduced LDL cholesterol from 106±22 to 87±33 mg/dL in the group r and omized to receive 80 mg of atorvastatin ( P<0.001 ) , whereas levels remained stable in the group r and omized to receive 10 mg ( 108±23 at baseline , 109±28 mg/dL at the end of the study , P = NS ) . The mean progression of CAC volume scores , corrected for the baseline CAC volume score , was 27 % ( 95 % CI 20.8 % to 33.1 % ) in the 80-mg atorvastatin group and 25 % ( 95 % CI 19.1 % to 30.8 % ) in the 10-mg atorvastatin group ( P=0.65 ) . CAC progression showed no relationship with on-treatment LDL cholesterol levels . Conclusions — We did not observe a relationship between on-treatment LDL cholesterol levels and the progression of calcified coronary atherosclerosis . Over a period of 12 months , intensive atorvastatin therapy was unable to attenuate CAC progression  compared with st and ard atorvastatin therapy . The possibility remains that the time window was too short to demonstrate an effect Background — Atrial fibrillation ( AF ) after cardiac surgery is associated with increased risk of complications , length of stay , and cost of care . Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF . We tested this observation in a r and omized , controlled trial . Methods and Results — Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass , without previous statin treatment or history of AF , were enrolled . Patients were r and omized to atorvastatin ( 40 mg/d , n=101 ) or placebo  ( n=99 ) starting 7 days before operation . The primary end point was incidence of postoperative AF ; secondary end points were length of stay , 30-day major adverse cardiac and cerebrovascular events , and postoperative C-reactive protein ( CRP ) variations . Atorvastatin significantly reduced the incidence of AF versus placebo ( 35 % versus 57 % , P=0.003 ) . Accordingly , length of stay was longer in the placebo versus atorvastatin arm ( 6.9±1.4 versus 6.3±1.2 days , P=0.001 ) . Peak CRP levels were lower in patients without AF ( P=0.01 ) , irrespective of r and omization assignment . Multivariable analysis showed that atorvastatin treatment conferred a 61 % reduction in risk of AF ( odds ratio 0.39 , 95 % confidence interval 0.18 to 0.85 , P=0.017 ) , whereas high postoperative CRP levels were associated with increased risk ( odds ratio 2.0 , 95 % confidence interval 1.2 to 7.0 , P=0.01 ) . The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms . Conclusions — Treatment with atorvastatin 40 mg/d , initiated 7 days before surgery , significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay . These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery Background —The early response of C-reactive protein to initiation of a hydroxymethylglutaryl coenzyme A reductase inhibitor ( statin ) is not known . The purpose of this study was to determine the rate at which highly sensitive C-reactive protein ( hsCRP ) levels change after initiation of simvastatin and whether this occurs independently of the change in LDL cholesterol . Methods and Results —The study was a crossover , double-blind design including 40 subjects with elevated LDL cholesterol . Subjects were r and omly assigned to 1 of 2 groups : simvastatin 40 mg for 14 days , then placebo for 14 days , or placebo first , then simvastatin . Simvastatin decreased LDL cholesterol by 56±4 mg/dL ( P < 0.0001 ) at day 7 and by an additional 8±3 mg/dL ( P = 0.02 ) at day 14 . Baseline log(hsCRP ) levels were similar in the 2 groups . By day 14 , log(hsCRP ) was significantly lower in patients on simvastatin when compared with placebo ( P = 0.011 ) . Although there was no significant difference in fibrinogen levels , simvastatin produced a modest increase in log[lipoprotein(a ) ] ( P = 0.03 ) at days 7 and 14 . There were no relationships between the decrease in LDL cholesterol and the decrease in hsCRP . Conclusions —Simvastatin  lowers hsCRP by 14 days , independent of its effect on LDL cholesterol . This rapid impact of a statin on hsCRP has potential implication s in the management of acute coronary syndromes BACKGROUND High levels of asymmetric dimethylarginine ( ADMA ) are associated with an increased risk of early recurrence of atrial fibrillation ( AF ) after electrical cardioversion . We aim ed to investigate the effects of rosuvastatin on serum ADMA levels and early recurrence of AF following successful electrical cardioversion . METHODS A total of 64 patients with persistent AF , but without known heart disease , who underwent elective electrical cardioversion were r and omized to the rosuvastatin ( group I , n = 32 ) and control ( group II , n = 32 ) groups . The end point was the recurrence of AF during the 3 months of follow-up . RESULTS The baseline ADMA levels were not different between the two groups . At the end of follow-up , serum ADMA levels in group I decreased compared with the baseline levels , whereas no significant change occurred in group II . During the follow-up , five patients in group I ( 15.6 % ) and 13 in group II ( 40.6 % ) had AF recurrence ( P < 0.05 , log-rank test ) . With the Cox proportional model , the predictors of recurrence included age > or = 65 years , left atrial diameter > 45 mm , and baseline ADMA levels > or = 2.0 micromol/l . Rosuvastatin was associated with a reduced risk of AF recurrence ( relative risk 0.35 , 95 % confidence interval 0.12 - 0.96 , P < 0.05 ) . CONCLUSIONS Rosuvastatin decreased the early recurrence of AF following successful electrical cardioversion with reduced ADMA levels BACKGROUND Increasing evidence suggests that atrial fibrillation ( AF ) is an inflammatory disease . Statins is an anti-inflammatory agent . The present study was conducted to test the efficacy of atorvastatin in preventing paroxysmal AF or atrial high rate episodes ( AHEs ) in patients with bradyarrhythmias and implantation of an atrial-based or dual-chamber pacemaker . METHODS The effect of atorvastatin on time to the first attack of AF or AHE ( > or = 180 per minute and > or = 1 or 10 minutes ) , which was accurately detected by pacemaker interrogation , was evaluated in an open-label prospect i ve r and omized design for 1 year of follow-up . RESULTS Fifty-two patients ( 23 males , 70 + /- 13 years old ) were r and omized to the  statin group ( atorvastatin 20 mg/d ) and 54 ( 25 males , 72 + /- 13 years old ) to the  nonstatin group . Event-free survivals from AHE > or = 1 minute were not significantly different between the 2 groups ( log-rank P = .410 ) . However , patients in the nonstatin group were more likely to develop AHE > or = 10 minutes than those in the statin group ( log-rank P = .028 ) . Atrial high rate episode > or = 10 minutes occurred in 3 ( 5.8 % ) of 51 patients in the statin group after 1 year of follow-up , and 10 ( 19.2 % ) of 52 patients ( odds ratio 0.26 , P = .041 ) in the nonstatin group . The mean left atrial volume of the statin group was significantly lower than that of the nonstatin group at the end of follow-up ( 39.7 + /- 1.7 vs 43.7 + /- 1.9 mL , P < .0001 ) . CONCLUSIONS The present study demonstrated the efficacy of atorvastatin in preventing significant AF ( > or = 10 minutes ) and left atrial enlargement in patients with bradyarrhythmias and implantation of a pacemaker Objectives We investigated the effects of short-term use of atorvastatin on CD34+/VEGF-R2+/CD133+/CD45- endothelial progenitor cell ( EPC ) count after on-pump coronary artery bypass surgery ( CABG ) . Methods Between Feb-2010 and May-2010 , we r and omly assigned , in a placebo-controlled , double-blind study , 60 consecutive patients who underwent isolated , first-time CABG to receive either 14-day atorvastatin  ( 40 mg/day ) or placebo  preoperatively . Urgent CABG and recent myocardial infa rct ion were excluded . EPCs were quantified ( cells/μl ) by flow cytometric phenotyping obtained from venous blood sample s collected preoperatively ( T1 ) , 6-hours ( T2 ) , and on the 5th day postoperatively ( T3 ) . Levels of markers of inflammation and serum cardiac troponin I were also measured preoperatively and daily until day-5 after surgery . Results There were no differences in baseline risk factors including cholesterol profiles , and EuroSCORES between the groups . The composite primary end-point , favored statin group with higher amount of circulating , early EPC count ( cells/μl ) at all time points compared with placebo ( T1 , 2.30 ± 0.02 versus 1.58 ± 0.03 , p < 0.001 ; T2 , 5.00 ± 0.06 versus 2.19 ± 0.06 , p < 0.001 ; T3 , 3.03 ± 0.08 versus 1.78 ± 0.02 , p < 0.001 ) . Postoperative hsCRP rise were inversely correlated with EPC count , and were significantly lower in the statin group ( T1 , 0.8 ± 0.1 versus 2.2 ± 1.5 , p < 0.001 ; T2 , 72.9 ± 3.2 versus 96.0 ± 3.6 , p < 0.001 ; T3 , 4.3 ± 1.2 versus 11.4 ± 4.1 , p < 0.001 ) . Furthermore , the incidence of postoperative atrial fibrillation was significantly lower in the statin group compared to placebo ( 3.3 % versus 23 % , p = 0.02 ) . Conclusions Short-term atorvastatin use increases circulating early EPCs both pre- and post-operatively and is associated with better preservation of sinus rhythm and reduced hsCRP levels . ( Clinical Trials.gov number , NCT01096875 AIMS Atrial fibrillation/flutter ( AF ) is the most common arrhythmia in older people . It associates with reduced exercise capacity , increased risk of stroke , and mortality . We aim ed to determine retrospectively whether pravastatin reduces the incidence of AF and whether any electrocardiographic measures or clinical conditions might be risk factors for its development . METHODS AND RESULTS The PROspect i ve Study of Pravastatin in the Elderly at Risk ( PROSPER ) was a r and omized , double-blind controlled trial that recruited 5804 individuals aged 70 - 82 years with a history of , or risk factors for , vascular disease . A total of 2891 were allocated to pravastatin  and 2913 to  placebo ; mean follow-up was 3.2 years .  Electrocardiograms ( ECGs ) , which were recorded at baseline , annually thereafter , and at run-out , were processed by computer and review ed manually . In all , 264 of 2912 ( 9.1 % ) of the placebo group and 283 of 2888 ( 9.8 % ) of the pravastatin-treated group developed AF [ hazard ratio 1.08 ( 0.92,1.28 ) , P= 0.35 ) ] . Multivariate analysis showed that PR and QTc intervals , age , left ventricular hypertrophy , and ST-T abnormalities were related to development of AF after adjustment for many variables including alcohol consumption , which itself was univariately predictive of developing AF . Previous myocardial infa rct ion on the ECG was not a risk factor . A history of vascular disease was strongly linked with developing AF but not diabetes and hypertension . CONCLUSION Pravastatin does not reduce the incidence of AF in older people at risk of vascular disease , at least in the short-medium term . Risk factors for AF include older age , prolongation of PR or QTc intervals , left ventricular hypertrophy , and ST-T abnormalities on the ECG Atrial fibrillation ( AF ) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting ( CABG ) . The aim of this study was to evaluate the effect of preoperative atorvastatin on postoperative atrial fibrillation  following coronary artery bypass grafting with cardiopulmonary bypass ( CCABG ) . One hundred consecutive patients undergoing elective CCABG , without history of AF or previous statin treatment , were enrolled and r and omly assigned to a statin group ( atorvastatin 20 mg/d , n = 49 ) or a control group ( placebo , n = 51 ) starting 7 days preoperatively . The primary endpoint was the occurrence of postoperative AF . C-reactive protein ( CRP ) levels were assessed in all selected patients before surgery and every 24 hours postoperatively until discharge from hospital . Atorvastatin significantly reduced the incidence of postoperative AF and postoperative peak CRP level versus placebo ( 18 % versus 41 % , P = 0.017 ; 129.3 ± 24.3 mg/L versus 149.3 ± 32.5 mg/L , P < 0.0001 ) . Kaplan-Meier curves confirmed a significantly better postoperative atrial fibrillation-free survival in the statin group ( χ(2 ) = 7.466 , P = 0.006 ) . Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF ( OR = 0.235 , P = 0.007 ) , whereas high postoperative CRP levels were associated with increased risk ( OR = 2.421 , P = 0.015 ) . Preoperative atorvastatin administration may inhibit inflammatory reactions to prevent atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass Endothelial progenitor cells ( EPCs ) are a subtype of hematopoietic stem cells , which contribute to the repair of injured endothelium . Treatment with atorvastatin has been shown to increase EPC count in patients with coronary artery disease . Therefore , we investigated whether atorvastatin augments the number of EPCs after cardiopulmonary bypass ( CPB ) surgery . We conducted a r and omized double-blind , placebo-controlled , 2-way crossover trial in 50 patients undergoing elective coronary surgery . Patients received either 3-week treatment with atorvastatin or placebo .  EPCs were quantitated by flow cytometric phenotyping on blood sample s. Levels of interleukin , IL-6 and IL-8 ; tumor necrosis factor α ; SDF-1α ; granulocyte colony-stimulating factor ; and vascular endothelial growth factor were determined at recruitment , preoperatively , post-CPB , and 6 , 12 , and 24 hours postoperatively . The atorvastatin group showed a significantly higher amount of EPCs both pre- and postoperatively compared with the placebo , with a > 4-fold increase compared with the baseline values . CPB induced an increase in all cytokines , but the levels of proinflammatory cytokines were significantly lower in the atorvastatin group ( P < 0.05 ) . Statin did not affect levels of SDF-1α , granulocyte colony-stimulating factor , and vascular endothelial growth factor . However , no correlation was found between plasma levels of any cytokine and number of EPCs , with the exception of SDF-1α . Pretreatment with atorvastatin significantly increases the amount of EPCs after CPB , by a mechanism independent of plasma levels of cytokines and cholesterol BACKGROUND Lipid-lowering drugs , particularly statins , have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation ( AF ) . This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis ( AS ) . METHODS Asymptomatic patients with mild-to-moderate AS ( n = 1,421 ) were r and omized ( 1:1 ) to double-blind  simvastatin 40 mg and ezetimibe 10 mg combination or placebo and followed up for a mean of 4.3 years . The primary end point was the time to new-onset AF adjudicated by 12-lead electrocardiogram  at a core laboratory reading center . Secondary outcomes were the correlates of new-onset AF with nonfatal nonhemorrhagic stroke and a combined end point of AS-related events . RESULTS During the course of the study , new-onset AF was detected in 85 ( 6 % ) patients ( 14.2/1,000 person-years of follow-up ) . At baseline , patients who developed AF were , compared with those remaining in sinus rhythm , older and had a higher left ventricular mass index a smaller aortic valve area index . Treatment with simvastatin and ezetimibe was not associated with less new-onset AF ( odds ratio 0.89 [ 95 % CI 0.57 - 1.97 ] , P = .717 ) . In contrast , age ( hazard ratio [ HR ] 1.07 [ 95 % CI 1.05 - 1.10 ] , P < .001 ) and left ventricular mass index ( HR 1.01 [ 95 % CI 1.01 - 1.02 ] , P < .001 ) were independent predictors of new-onset AF . The occurrence of new-onset AF was independently associated with 2-fold higher risk of AS-related outcomes ( HR 1.65 [ 95 % CI 1.02 - 2.66 ] , P = .04 ) and 4-fold higher risk of nonfatal nonhemorrhagic stroke ( HR 4.04 [ 95 % CI 1.18 - 13.82 ] , P = .03 ) . CONCLUSIONS Simvastatin and ezetimibe were not associated with less new-onset AF . Older age and greater left ventricular mass index were independent predictors of AF development . New-onset AF was associated with a worsening of prognosis OBJECTIVE Myocardial disease without evidence of myocardial infa rct ion is a frequent complication after cardiac surgery during cardiopulmonary bypass .  Statins might be protective , but their efficacy has not been established in r and omized trials . METHODS Two hundred patients undergoing coronary surgery were enrolled . They were r and omized to rosuvastatin ( 20 mg/d , n = 100 ) or placebo ( n = 100 ) starting 1 week before the operation . Troponin I , myoglobin , creatine kinase-MB mass , and high-sensitivity C-reactive protein were used as markers of myocardial injury , and their values were determined at baseline and at regular intervals after the operation .  Electrocardiography and echocardiography  were performed before and after the operation . RESULTS Myocardial disease was diagnosed when troponin I , myoglobin , and creatine kinase-MB mass values were above the upper normal limit without evidence of electrocardiographic changes , echocardiographic changes , or both . The percentages of marker level increase indicative of myocardial disease were determined in the placebo versus statin groups and were as follows : troponin I , 35 % versus 65 % ( P < .0001 ) ; myoglobin , 39 % versus 72 % ( P < .0001 ) ; creatine kinase-MB mass , 22 % versus 40 % ( P = .0002 ) . Peak postoperative values of troponin I ( 0.16 + /- 0.15 vs 0.32 + /- 0.26 ng/mL , P = .0008 ) , myoglobin ( 72.25 + /- 25 vs 98.31 + /- 31 ng/mL , P < .0001 ) , and creatine kinase-MB mass ( 3.9 + /- 3.3 vs 9.3 + /- 8.1 ng/mL , P < .0001 ) were significantly higher in the placebo group . High-sensitivity C-reactive protein values were increased in 58 % of pretreated versus 88 % of the control patients ( 15.4 + /- 2.5 vs 17.2 + /- 3.4 mg/L , P < .0001 ) . In high-risk patients myocardial disease was observed more frequently but significantly less in statin-pretreated patients . CONCLUSIONS Statin pretreatment reduces myocardial damage after coronary surgery and could improve both short- and long-term results Objective : In this study , our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation ( AF ) after electrical cardioversion ( EC ) in addition to antiarrhythmic therapy . Subjects and Methods : 48 patients with persistent AF were included in this study . The patients were r and omized to an atorvastatin 40-mg treatment group and a control group . Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC . EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin .  Lipid and inflammatory parameters ( high-sensitivity C-reactive protein , white blood cell count and fibrinogen level ) were evaluated at the baseline and before EC . The endpoint of this study was electrocardiographically confirmed recurrence of AF of > 10 min . Results : There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups . Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values ( 174 ± 31 vs. 129 ± 25 mg/dl , p = 0.001 , and 112 ± 23 vs. 62 ± 20 mg/dl , p = 0.001 , respectively ) , while no significant change occurred in control patients ( 168 ± 26 vs. 182 ± 29 mg/dl , p = 0.07 , and 99 ± 18 vs. 108 ± 26 mg/dl , p = 0.1 , respectively ) . At the end of the 2-month follow-up period , 9 patients ( 20.5 % ) experienced AF recurrence , and there was no significant difference in AF recurrence rate between the treatment and control groups ( 26 vs. 13 % ; p = 0.2 ) . Conclusion : Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy BACKGROUND It is known that statins are effective in preventing atrial fibrillation ( AF ) in patients undergoing cardiac surgery . OBJECTIVE The purpose of this study was to evaluate the efficacy of statins in preventing AF recurrence following left atrial ablation . METHODS One hundred twenty-five patients who had no statin indication undergoing catheter ablation due to drug-refractory paroxysmal ( n = 90 ) or persistent ( n = 35 ) AF were r and omized in a prospect i ve , double-blind , placebo-controlled trial to receive 80 mg atorvastatin ( n = 62 ) or placebo ( n = 63 ) for 3 months . The primary endpoint was freedom from symptomatic AF at 3 months . Secondary endpoints included freedom from any atrial arrhythmia recurrence irrespective of symptoms , quality of life ( QoL ) , and reduction in C-reactive protein ( CRP ) . RESULTS At 3 months , 95 % of patients in the atorvastatin group were free of symptomatic AF compared with 93.5 % in the placebo group ( P = .75 ) . Similarly , 85 % of patients treated in the atorvastatin group remained free of any recurrent atrial arrhythmia vs 88 % of patients in the placebo group ( P = .37 ) . Mean CRP levels decreased in the atorvastatin group ( mean change -0.75 ± 3 , P = .02 ) and increased in the placebo group ( mean change 2.1 ± 19.9 , P = .48 ) . Mean QoL score improved significantly in both groups ( mean change 13.14 ± 18.2 in the atorvastatin group and 11.10 ± 17.7 in the placebo group , P = .53 ) . CONCLUSION In patients with no st and ard indication for statin therapy  , treatment with atorvastatin 80 mg/day following AF ablation does not decrease the risk of AF recurrence in the first 3 months and should not be routinely administered to prevent periprocedural arrhythmias BACKGROUND Atrial fibrillation ( AF ) after coronary artery bypass grafting ( CABG ) is still the most common postoperative arrhythmic complication . Previous studies report that patients undergoing preoperative statin  therapy had a lower incidence of postoperative AF . This study aim ed to assess the effect of preoperative atorvastatin therapy on preventing AF following off-pump CABG in a r and omized , controlled trial . METHODS AND RESULTS The 140 consecutive patients undergoing elective off-pump CABG , without a history of AF or previous statin treatment , were enrolled and r and omly assigned to a statin ( atorvastatin 20 mg/day , n=71 ) or a control group ( placebo , n=69 ) starting 7 days preoperatively . The primary endpoint was the occurrence of postoperative AF ; secondary endpoints were major adverse in-hospital cardiac and cerebrovascular events and identification of variables predicting postoperative AF .  Atorvastatin significantly reduced the incidence of postoperative AF and the postoperative peak C-reactive protein ( CRP ) level vs placebo ( 14 % vs 34 % , P=0.009 ; 126.5 + /-22.3 vs 145.2 + /-31.6 mg/L , P<0.0001 ) . Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF ( odds ratio ( OR ) 0.219 , P=0.005 ) , whereas a high postoperative CRP level was associated with increased risk ( OR 2.011 , P=0.013 ) . CONCLUSIONS Administration of atorvastatin 20 mg/day , initiated 1 week before elective off-pump CABG and continued in the postoperative period , significantly decreases postoperative AF BACKGROUND Inflammation has been suggested as a factor in the initiation and maintenance of  atrial fibrillation ( AF ) . Several observational studies have suggested that statins , presumably through their anti-inflammatory properties , decrease the risk of AF . METHODS We analyzed 2 large , r and omized trials , PROVE IT-TIMI 22 and phase Z of the A to Z trial , which compared lower- versus higher-intensity statin therapy to evaluate whether higher-intensity statin therapy lowered the risk of AF onset during the 2 years of follow-up . We hypothesized that higher-intensity statin therapy would decrease the risk of AF when compared to lower-intensity statin therapy . From each trial , patients experiencing the onset of AF during follow-up were identified from the adverse event reports . RESULTS Neither study showed a decreased AF risk with higher-dose statin . In PROVE IT-TIMI 22 , 2.9 % versus 3.3 % in the high- versus st and ard-dose statin therapy , respectively , experienced the onset of AF over 2 years ( OR 0.86 , 95 % CI 0.61 - 1.23 , P = .41 ) . In A to Z , rates were 1.6 % versus 0.99 % , respectively ( OR 1.58 , 95 % CI 0.92 - 2.70 , P = .096 ) . In both trials , C-reactive protein levels ( plasma or serum ) tended to be higher among patients experiencing the onset of AF . CONCLUSION Our r and omized comparison among 8659 patients found that higher-dose statin therapy did not reduce the short term incidence of AF among patients after acute coronary syndromes when compared with st and ard dose statin treatment BACKGROUND While statins are increasingly used in cardiopulmonary bypass ( CPB ) , the anti-inflammatory effects of individual statins , within the context of various treatment regimes , need further examination . The present study evaluates the anti-inflammatory effectiveness of the short-term , preoperative and intensive postoperative use of pravastatin in CPB . METHOD Forty three patients undergoing CPB were enrolled in a r and omized , prospect i ve clinical study . One group ( n = 21 ) , received pravastatin , the other ( n = 22 ) did not . Patients in the pravastatin group received one dose of 40 mg per day for nine days , starting 48 hours before CPB , with an additional dose of 40 mg one hour after surgery . Plasma levels of selected inflammatory mediators were measured at baseline and tracked systematic ally . RESULTS Pravastatin reduced postoperative interleukin-6 ( IL-6 ) levels significantly at 24 and 48 hours , and at seven days . Mean + /- SD values , for treated versus untreated patients were : at 24 hours , 159.5 + /- 58.5 versus 251.2 + /- 53.0 pg/mL ( p < 0.001 ) ; at 48 hours , 81.9 + /- 31.5 versus 194.2 + /- 56.3 pg/mL ( p < 0.001 ) ; and at seven days , 16.4 + /- 7.2 versus 30.8 + /- 12.6 ( p < 0.001 ) . C-reactive protein ( CRP ) decreased significantly on the seventh postoperative day , when plasma levels were 3.6 + /- 1.1 in the treated patients versus 8.2 + /- 2.1 mg/dL in the controls ( p < 0.001 ) . No changes in plasma IL-1 and TNF-alpha were found during entire study . CONCLUSIONS Pravastatin induced a precocious modulation of IL-6 expression and a later reduction of plasma CRP levels .  Pravastatin;s effects on the expression of these pivotal inflammatory mediators strongly support its well-timed use in CPB OBJECTIVE The preventative effect of statins on  postoperative atrial fibrillation  has been hypothesized . However , all studies to date have examined patients who did not receive statins  before their further allocation to treatment or no treatment . Because guidelines recommend the routine use of statins in patients with coronary artery disease , we set out to examine the effect of intensive statin pretreatment versus continuation of usual statin dose on atrial fibrillation after cardiac surgery . METHODS Patients receiving routine statin treatment and undergoing coronary artery bypass surgery or aortic valve replacement with no history of atrial fibrillation or antiarrhythmic medication were r and omized to receive atorvastatin 80 mg or atorvastatin 10 mg for 7 days before surgery in a single-blind fashion . The primary end point was the development of postoperative atrial fibrillation during hospital stay . RESULTS A total of 104 consecutive patients were included . Postoperative atrial fibrillation occurred in 33 patients ( 32.4 % ) . No significant differences were found in demographics , medical history , or intraoperative variables between treatment groups , with the exception of higher rate of β-blocker use in the atorvastatin 10 mg group ( 75 % vs 53 % , P = .002 ) and previous myocardial infa rct ion ( 62 % vs 42 % , P = .049 ) . The incidence of postoperative atrial fibrillation was lower in the atorvastatin 80 mg group when compared with the atorvastatin 10 mg group , but this difference did not reach statistical significance ( 29 % vs 36 % , P = .43 ) . CONCLUSIONS High-dose atorvastatin for 7 days before cardiac surgery conferred a nonsignificant reduction in postoperative atrial fibrillation when compared with a low-dose regimen . A larger study would be necessary to confirm the beneficial effect of high-dose statins in this setting BACKGROUND C-reactive protein ( CRP ) lowering is associated with a reduction in recurrent and permanent atrial fibrillation . This study sought to determine whether CRP lowering also results in a reduction of paroxysmal atrial fibrillation ( PAF ) during daily life . METHODS AND RESULTS We enrolled 80 patients with proven PAF , CRP between 0.8 and 13 mg/L , and at least 1 episode of PAF on ambulatory electrocardiographic monitoring . Forty patients were r and omized to placebo ( placebo group ) and 40 to atorvastatin ( treatment group ) .  Plasma  CRP levels and ambulatory monitoring were repeated after 4 to 6 months of therapy . The 2 groups were comparable with respect to baseline characteristics , number of episodes of PAF , and baseline plasma CRP levels . The treatment group had lower median CRP levels at study end and experienced a significant reduction in the number of episodes of PAF compared with the placebo group . Paroxysmal atrial fibrillation was completely resolved in 26 ( 65 % ) of 40 patients in the treatment group versus 4 ( 10 % ) of 40 in the placebo group . The treatment group exhibited a highly significant reduction in PAF ( P < .001 ) . By logistic regression , treatment with atorvastatin was an independent predictor of PAF resolution . CONCLUSIONS C-reactive protein lowering with atorvastatin appears to be effective in eliminating PAF during daily life in a significant proportion of patients AIMS To evaluate the effect of atorvastatin in achieving stable sinus rhythm ( SR ) 30 days after electrical cardioversion ( CV ) in patients with persistent atrial fibrillation ( AF ) . METHODS AND RESULTS The study included 234 patients . The patients were r and omized to treatment with atorvastatin 80 mg daily ( n = 118 ) or placebo ( n = 116 ) in a prospect i ve , double-blinded fashion . Treatment was initiated 14 days before CV and was continued 30 days after CV . The two groups were well-balanced with respect to baseline characteristics . Mean age was 65 + /- 10 years , 76 % of the patients were male and 4 % had ischaemic heart disease . Study medication was well-tolerated in all patients but one . Before primary endpoint 12 patients were excluded . In the atorvastatin group 99 patients ( 89 % ) converted to SR at electrical CV compared with 95 ( 86 % ) in the placebo group ( P = 0.42 ) . An intention-to-treat analysis with the available data , by r and omization group , showed that 57 ( 51 % ) in the atorvastatin group and 47 ( 42 % ) in the placebo group were in SR 30 days after CV ( OR 1.44 , 95%CI 0.85 - 2.44 , P = 0.18 ) . CONCLUSION Atorvastatin was not statistically superior to placebo with regards to maintaining SR 30 days after CV in patients with persistent AF BACKGROUND  Atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery is still the most common arrhythmic complication . This study evaluated whether pretreatment with atorvastatin protects against AF after off-pump CABG . METHODS One hundred twenty-four patients without a history of AF or previous statin use , who were scheduled to undergo elective off-pump CABG , were enrolled . Patients were r and omized to control group ( n = 62 ) or to atorvastatin group ( n = 62 ) who were administered  atorvastatin 20 mg/d for 3 days before the surgery . Primary outcome was the incidence of postoperative AF . Secondary outcomes were major adverse cardiac and cerebrovascular events , persistent AF at 1 month , and identification of the markers to predict inhospital postoperative AF . RESULTS The incidence of AF was significantly lower in the atorvastatin group than in the control group ( 13 % vs 27 % , P = .04 ) . The incidence of major adverse cardiac and cerebrovascular events and persistent AF at 1 month was similar in comparisons between the groups . Postoperative peak N-terminal pro-brain natriuretic peptide levels were significantly higher in the patients with AF ( P = .03 ) . Multivariate analysis identified pretreatment with atorvastatin as an independent factor associated with a significant reduction in postoperative AF ( odds ratio 0.34 , P = .04 ) . Higher postoperative peak N-terminus pro-B-type natriuretic peptide levels were associated with the development of postoperative AF ( odds ratio 1.02 per 100 pg/mL , P = .03 ) . CONCLUSIONS Pretreatment with atorvastatin significantly reduced the occurrence of postoperative AF after off-pump CABG BACKGROUND Observational analyses and short-term r and omized trials have suggested that statins reduce occurrence or recurrence of atrial fibrillation ( AF ) . We tested the hypothesis that long-term treatment with high-dose atorvastatin reduces occurrence of AF in patients with prior stroke or transient ischemic attack . METHODS We examined development of new AF in the SPARCL trial that compared atorvastatin 80 mg daily with placebo in 4,731 patients with prior stroke or transient ischemic attack . Patients who had chronic or paroxysmal AF or were taking medications for treatment or prophylaxis of AF at the time of enrollment were excluded .  Atrial fibrillation was identified from electrocardiograms su bmi tted to a blinded central electrocardiographic laboratory and from investigators ' adverse event reports . RESULTS Patients were followed up for a median of 4.8 years , corresponding to > 20,000 patient-years of observation with a median of 5 electrocardiograms per patient . The primary efficacy measure , the time from r and omization to first occurrence of new AF , did not differ between treatment groups . By intention to treat , there were 139 cases of new AF in the atorvastatin group and 122 cases in the placebo group , corresponding to incidence rates of 1.32 and 1.14 cases per 100 patient-years observation ( hazard ratio 1.15 , 95 % CI 0.90 - 1.46 , P = .26 ) . On-treatment analysis yielded similar findings , with incidence rates of 1.26 and 1.01 cases per 100 patient-years observation in the atorvastatin and placebo groups , respectively ( hazard ratio 1.25 , 95 % CI 0.94 - 1.67 , P = .12 ) . CONCLUSION High-dose atorvastatin does not prevent development of AF in patients with prior stroke or transient ischemic attack AIM Cardiopulmonary bypass is associated with a complex systemic inflammatory response and the extent of their increase has been correlated with the development of postoperative complications . Recent studies suggest that treatment with statins is associated with a significant and marked decrease in inflammation-associated variables such as cytokines . Therefore , we investigated the effects of preoperative simvastatin treatment on systemic inflammatory response and perioperative morbidity after cardiopulmonary bypass . METHODS A prospect i ve , r and omized study , was design ed . Forty-four subjects undergoing elective coronary artery bypass grafting who fulfilled the inclusion criteria were r and omized to treatment with  simvastatin ( 20 mg/day , group A , N. 22 ) or control ( group B , N. 22 ) before surgery . Plasma levels of interleukins ( IL-6 , IL-8 , TNF-alpha ) , and systemic inflammatory response score ( SIRS ) were measured during the surgical intervention and over the following 48 postoperative hours . Cytokine levels were measured by enzyme-linked assays from plasma sample s obtained at specific time points pre- and post-operation . RESULTS In both groups the serum levels of the proinflammatory cytokines ( IL-6 , IL-8 , TNF-alpha ) , and leukocytes , and the SIRS score increased significantly over the baseline , though no significant differences were observed between the two groups . The preoperative and postoperative course did not differ between both groups . CONCLUSIONS In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass , the administration of simvastatin doses not produce any changes in the inflammatory response as measured by the levels of IL-6 , IL-8 , TNF-alpha and SIRS score , nor does it reduce the complications after cardiac surgery To test the hypothesis that a statin could reduce the recurrence rate of atrial fibrillation after electrical cardioversion ( EC ) , we performed an open , controlled multicenter study . Patients ( n = 114 ) who had atrial fibrillation > 48 hours and who were scheduled for EC were r and omized to receive 40 mg of pravastatin once daily for 3 weeks before and 6 weeks after EC or no drug in addition to st and ard therapy . Pravastatin did not reduce the recurrence rate of atrial fibrillation after EC AIMS Increasing evidence supports a role for inflammation in promoting  atrial fibrillation ( AF ) and statins have anti-inflammatory effects that may be relevant for the prevention of AF . However , studies of statin therapy and incident AF have yielded mixed results and not focused on individuals with an underlying pro-inflammatory response . We studied whether high-sensitivity C-reactive protein is associated with incident AF and whether treatment with rosuvastatin is associated with a lower incidence of AF compared with placebo . METHODS AND RESULTS We r and omized men and women with LDL cholesterol < 130 mg/dL and high-sensitivity C-reactive protein ≥2 mg/L to receive either rosuvastatin 20 mg daily or placebo .  Atrial fibrillation was determined from treatment-blind adverse event reports . Among 17 120 participants without prior history of arrhythmia , each increasing tertile of baseline high-sensitivity C-reactive protein was associated with a 36 % increase in the risk of developing AF ( 95 % CI : 1.16 - 1.60 ; P-trend < 0.01 ) . Allocation to rosuvastatin when compared with placebo was associated with a 27 % reduction in the relative risk of developing AF during the trial period ; specifically , AF was reported among 138 participants in the placebo group and 100 in the rosuvastatin group ( incidence rate 0.78 vs. 0.56/100 person-years , HR : 0.73 , 95 % CI : 0.56 - 0.94 , P = 0.01 ) . The exclusion of participants who developed a major cardiovascular event prior to the report of AF yielded similar results . CONCLUSION Within the JUPITER trial cohort of individuals selected for underlying inflammation , increasing levels of high-sensitivity C-reactive protein were associated with an increased risk of incident AF and r and om allocation to rosuvastatin significantly reduced that risk To study the effect of atorvastatin on recurrence of atrial fibrillation ( AF ) after electrical cardioversion ( EC ) , 48 patients with AF lasting 48 hours who were scheduled for EC were r and omized to the atorvastatin ( group I ) and control ( group II ) groups . Six patients in group I ( 25 % ) and 2 patients in group II ( 8.3 % ) had spontaneous conversion before EC ( p > 0.05 ) . The end point was the recurrence of AF during 3 months of follow-up . Eighteen patients in group I ( 12.5 % ) and 11 patients in group II ( 45.8 % ) had recurrence ( p = 0.01 , log-rank test ) . With the Cox proportional model , the predictors of recurrence included a body mass index of 25 to 30 kg/m2 ( relative risk [ RR ] 0.07 , 95 % confidence interval [ CI ] 0.008 to 0.59 ) , body mass index > or = 30 kg/m2 ( RR 0.24 , 95 % CI 0.08 to 0.72 ) , AF duration of > or = 3 months ( RR 0.28 , 95 % CI 0.09 to 0.83 ) , diabetes mellitus ( RR 0.34 , 95 % CI 0.12 to 0.98 ) , and left atrial diameter of > or = 45 mm ( RR 0.23 , 95 % CI 0.07 to 0.74 ) . Atorvastatin was associated with a significantly reduced risk of developing AF ( unadjusted RR 0.23 , 95 % CI 0.064 to 0.82 , p = 0.024 ) . This association remained significant after adjustment for these predictors ( adjusted RR 0.19 , 95 % CI 0.052 to 0.72 , p = 0.01 ) . High-sensitivity C-reactive protein levels at baseline were not different between the 2 groups ( p = 0.92 ) . Although the high-sensitivity C-reactive protein levels decreased significantly 48 hours after EC compared with the baseline levels in group I ( 2.82 + /- 1.46 vs 2.56 + /- 1.3 mg/dl , p = 0.02 ) , no significant change occurred in group II ( 2.87 + /- 0.8 vs 2.84 + /- 0.8 mg/dl , p = 0.09 ) . In conclusion , atorvastatin decreased the recurrence rate of AF after EC Objectives : Systemic inflammatory response occurs frequently after coronary artery bypass surgery , and it is strongly correlated with the risk of postoperative morbidity and mortality . Recent studies demonstrate that treatment with statin is associated with a significant and marked decrease in inflammation-associated variables such as the C-reactive protein , cytokines , and adhesion molecules . Therefore , we investigated the effects of preoperative atorvastatin treatment on systemic inflammatory response and perioperative morbidity after cardiopulmonary bypass . Design : Double-blinded , placebo-controlled , r and omized study . Setting : University hospital . Patients : Forty patients were r and omized to treatment with atorvastatin ( 20 mg/day , group A , n = 20 ) or placebo ( group B , n = 20 ) 3 wks before surgery . Interventions : Three-week treatment by atorvastatin 20 mg/day . Measurement and Main Results : Postoperative serum levels of both interleukin-6 and interleukin-8 increased significantly over baseline , but the peak levels observed 4 hrs postoperatively were significantly lower in the atorvastatin group . In the same fashion , CD11b expression on neutrophils was significantly lower in the statin group at 4 and 24 hrs postoperatively . Finally , neutrophil-endothelial adhesion was significantly reduced in the statin patients compared with controls . The operation time , blood loss , need for inotropic support , intubation time , and length of intensive care unit or hospital stay did not differ significantly between the two groups . The systemic inflammatory response syndrome score on postoperative days 1 and 2 was comparable in both groups . Conclusions : Pretreatment with atorvastatin significantly reduces cytokine release and neutrophil adhesion to the venous endothelium in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass
target: SUMMARY The use of statins was significantly associated with a decreased risk of atrial fibrillation in patients with sinus rhythm .
background: PURPOSE OF REVIEW Whether statins may prevent  atrial fibrillation  remains a subject of debate .