1
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Mekhael M, Marrouche N, Hajjar AHE, Donnellan E. The relationship between atrial fibrillation and coronary artery disease: Understanding common denominators. Trends Cardiovasc Med 2024; 34:91-98. [PMID: 36182022 DOI: 10.1016/j.tcm.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 01/04/2023]
Abstract
Atrial fibrillation (AF) and coronary artery disease (CAD) are highly prevalent cardiovascular conditions. The coexistence of both diseases is common as they share similar risk factors and common pathophysiological characteristics. Systemic inflammatory conditions are associated with an increased incidence of both AF and CAD. The presence of both entities increases the incidence of complications and adverse outcomes. Furthermore, their coexistence poses challenges for the management of patients, particularly with respect to anticoagulation and rhythm management. In this review, we aim to better understand the relationship between AF and CAD by detailing basic molecular pathophysiology, assessing therapeutic guidelines, and describing interactions between the two conditions.
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Affiliation(s)
- Mario Mekhael
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Eoin Donnellan
- Tulane University School of Medicine, New Orleans, LA, USA.
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2
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Heravi AS, Zhao D, Michos ED, Doria De Vasconcellos H, Ambale-Venkatesh B, Lloyd-Jones D, Schreiner PJ, Reis JP, Shikany JM, Lewis CE, Ndumele CE, Guallar E, Ouyang P, Hoogeveen RC, Lima JAC, Post WS, Vaidya D. Oxidative Stress and Cardiovascular Risk Factors: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Antioxidants (Basel) 2023; 12:antiox12030555. [PMID: 36978803 PMCID: PMC10044794 DOI: 10.3390/antiox12030555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction—Oxidative stress is linked to cardiovascular diseases (CVD) and is suggested to vary by sex. However, few population-level studies have explored these associations and the majority comprise populations with advanced CVD. We assessed urinary isoprostane concentrations, a standard measure of oxidative stress, in a relatively young and healthy cohort, hypothesizing that higher oxidative stress is associated with an adverse cardiometabolic profile and female sex. Methods—Oxidative stress was measured in 475 women and 266 men, aged 48–55 years, from the Coronary Artery Risk Development in Young Adults (CARDIA) study using urinary 8-isoprostane (IsoP) and 2,3-dinor-8-isoprostane (IsoP-M). Multivariable-adjusted regression was used to evaluate cross-sectional associations. As secondary analysis, previously measured plasma F2-isoprostanes (plasma IsoP) from another CARDIA subset was similarly analyzed. Results—Mean (SD) ages for men and women were 52.1(2.3) and 52.2(2.2) years, respectively (p = 0.46), and 39% of the participants self-identified as Black (vs. White). Before adjustments, female sex was associated with higher median urinary IsoP (880 vs. 704 ng/g creatinine in men; p < 0.01) and IsoP m (1675 vs. 1284 ng/g creatinine in men; p < 0.01). Higher body mass index (BMI), high-density cholesterol (HDL-C), and triglycerides, current smoking, and less physical activity were associated with higher oxidative stress. Diabetes was not associated with urinary IsoP but was associated with lower IsoP m and plasma IsoP. Higher serum creatinine showed diverging associations with higher plasma and lower urinary isoprostane concentrations. Conclusions—Different isoprostane entities exhibit varying association patterns with CVD risk factors, and therefore are complementary, rather than interchangeable, in assessment of oxidative stress. Still, consistently higher isoprostanes among women, smokers, less active persons, and those with higher BMI and plasma triglycerides could reflect higher oxidative stress among these groups. While urinary isoprostanes are indexed to urinary creatinine due to variations in concentration, caution should be exercised when comparing groups with differing serum creatinine.
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Affiliation(s)
- Amir S. Heravi
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Di Zhao
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Erin D. Michos
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | | | - Donald Lloyd-Jones
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| | - Pamela J. Schreiner
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jared P. Reis
- National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA
| | - James M. Shikany
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Cora E. Lewis
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Chiadi E. Ndumele
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Eliseo Guallar
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Pamela Ouyang
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | - Joao A. C. Lima
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Wendy S. Post
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Dhananjay Vaidya
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
- Correspondence:
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3
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Kokina B, Kalejs O, Maca A, Strelnieks A, Jubele K, Rudaka I, Apsite K, Lejnieks A. Atrial Fibrillation Recurrence Prevention after Electrical Cardioversion in High-Risk Patients – Benefits of Non-Antiarrhythmic Drugs. Open Cardiovasc Med J 2021. [DOI: 10.2174/1874192402115010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results.
Objective:
We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients.
Methods:
The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews.
Results:
113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308).
Conclusion:
Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.
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Fiedler L, Hallsson L, Tscharre M, Oebel S, Pfeffer M, Schönbauer R, Tokarska L, Stix L, Haiden A, Kraus J, Blessberger H, Siebert U, Roithinger FX. Upstream Statin Therapy and Long-Term Recurrence of Atrial Fibrillation after Cardioversion: A Propensity-Matched Analysis. J Clin Med 2021; 10:jcm10040807. [PMID: 33671264 PMCID: PMC7922984 DOI: 10.3390/jcm10040807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
The relationship of statin therapy with recurrence of atrial fibrillation (AF) after cardioversion (CV) has been evaluated by several investigations, which provided conflicting results and particularly long-term data is scarce. We sought to examine whether upstream statin therapy is associated with long-term recurrence of AF after CV. This was a single-center registry study including consecutive AF patients (n = 454) undergoing CV. Cox regression models were performed to estimate AF recurrence comparing patients with and without statins. In addition, we performed a propensity score matched analysis with a 1:1 ratio. Statins were prescribed to 183 (40.3%) patients. After a median follow-up period of 373 (207–805) days, recurrence of AF was present in 150 (33.0%) patients. Patients receiving statins had a significantly lower rate of AF recurrence (log-rank p < 0.001). In univariate analysis, statin therapy was associated with a significantly reduced rate of AF recurrence (HR 0.333 (95% CI 0.225–0.493), p = 0.001), which remained significant after adjustment (HR 0.238 (95% CI 0.151–0.375), p < 0.001). After propensity score matching treatment with statins resulted in an absolute risk reduction of 27.5% for recurrent AF (21 (18.1%) vs. 53 (45.7%); p < 0.001). Statin therapy was associated with a reduced risk of long-term AF recurrence after successful cardioversion.
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Affiliation(s)
- Lukas Fiedler
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria; (L.H.); (U.S.)
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
- Correspondence: ; Tel.: 0043 2622/9004-22703
| | - Lára Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria; (L.H.); (U.S.)
| | - Maximilian Tscharre
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
| | - Sabrina Oebel
- Department of Cardiac Electrophysiology, Helios Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany;
| | - Michael Pfeffer
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
| | - Robert Schönbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria;
| | - Lyudmyla Tokarska
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
| | - Laura Stix
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria;
| | - Anton Haiden
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
| | - Johannes Kraus
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, 4040 Linz, Austria;
- Johannes Kepler University Linz, Medical Faculty, 4040 Linz, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria; (L.H.); (U.S.)
- Center for Health Decision Science and Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Franz Xaver Roithinger
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria; (M.T.); (M.P.); (L.T.); (L.S.); (A.H.); (F.X.R.)
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Nomani H, Saei S, Johnston TP, Sahebkar A, Mohammadpour AH. The Efficacy of Anti-inflammatory Agents in the Prevention of Atrial Fibrillation Recurrences. Curr Med Chem 2021; 28:137-151. [PMID: 32116184 DOI: 10.2174/1389450121666200302095103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
Several studies have indicated an association between inflammation and the recurrence of Atrial Fibrillation (AF), especially after ablation, which is a therapeutic option leading to local inflammation. On the other hand, each AF can lead to another AF, as a general rule. Thus, preventing recurrences of AF is extremely important for patient outcomes. In this paper, we attempted to review the effect of medicinal agents with anti-inflammatory properties on the prevention of AF recurrence. There are several randomized controlled trials (RCTs) and meta-analyses on the prevention of AF recurrence using agents with anti-inflammatory properties, which include steroids, colchicine, statins, and n-3 fatty acids (n-3 FA). Clinical trials evaluating the efficacy of anti-inflammatory drugs in preventing the recurrence of AF led to inconsistent results for corticosteroids, statins and n-3 FAs. These results may be related to the fact that inflammation is not the only factor responsible for triggering recurrences of AF. For example, the presence of structural, mechanical and electrical remodeling could potentially be the most important factors that trigger recurrences of AF but these factors have not been addressed in most of the reported studies. Therefore, future clinical trials are needed to compare the efficacy of anti-inflammatory drugs in AF patients with, or without other factors. For colchicine, a potent anti-inflammatory drug, there are limited studies. However, all the studies investigating colchicine in the context of AF were consistent and promising, especially when colchicine was used on a short-term basis following ablation in patients with paroxysmal AF. Therefore, colchicine could be a promising candidate for further clinical studies involving recurrent AF.
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Affiliation(s)
- Homa Nomani
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Thomas P Johnston
- Division of Pharmacology and Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, United States
| | | | - Amir Hooshang Mohammadpour
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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6
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Salazar-Ramírez F, Ramos-Mondragón R, García-Rivas G. Mitochondrial and Sarcoplasmic Reticulum Interconnection in Cardiac Arrhythmia. Front Cell Dev Biol 2021; 8:623381. [PMID: 33585462 PMCID: PMC7876262 DOI: 10.3389/fcell.2020.623381] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/30/2020] [Indexed: 12/31/2022] Open
Abstract
Ca2+ plays a pivotal role in mitochondrial energy production, contraction, and apoptosis. Mitochondrial Ca2+-targeted fluorescent probes have demonstrated that mitochondria Ca2+ transients are synchronized with Ca2+ fluxes occurring in the sarcoplasmic reticulum (SR). The presence of specialized proteins tethering SR to mitochondria ensures the local Ca2+ flux between these organelles. Furthermore, communication between SR and mitochondria impacts their functionality in a bidirectional manner. Mitochondrial Ca2+ uptake through the mitochondrial Ca2+ uniplex is essential for ATP production and controlled reactive oxygen species levels for proper cellular signaling. Conversely, mitochondrial ATP ensures the proper functioning of SR Ca2+-handling proteins, which ensures that mitochondria receive an adequate supply of Ca2+. Recent evidence suggests that altered SR Ca2+ proteins, such as ryanodine receptors and the sarco/endoplasmic reticulum Ca2+ ATPase pump, play an important role in maintaining proper cardiac membrane excitability, which may be initiated and potentiated when mitochondria are dysfunctional. This recognized mitochondrial role offers the opportunity to develop new therapeutic approaches aimed at preventing cardiac arrhythmias in cardiac disease.
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Affiliation(s)
- Felipe Salazar-Ramírez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Cátedra de Cardiología y Medicina Cardiovascular, Monterrey, Mexico
| | - Roberto Ramos-Mondragón
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, United States.,Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Gerardo García-Rivas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Cátedra de Cardiología y Medicina Cardiovascular, Monterrey, Mexico.,TecSalud, Centro de Investigación Biomédica, Hospital Zambrano-Hellion, San Pedro Garza García, Mexico.,TecSalud, Centro de Medicina Funcional, Hospital Zambrano-Hellion, San Pedro Garza García, Mexico
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7
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Abstract
BACKGROUND Statins are one of the most prescribed classes of drugs worldwide. Atorvastatin, the most prescribed statin, is currently used to treat conditions such as hypercholesterolaemia and dyslipidaemia. By reducing the level of cholesterol, which is the precursor of the steroidogenesis pathway, atorvastatin may cause a reduction in levels of testosterone and other androgens. Testosterone and other androgens play important roles in biological functions. A potential reduction in androgen levels, caused by atorvastatin might cause negative effects in most settings. In contrast, in the setting of polycystic ovary syndrome (PCOS), reducing excessive levels of androgens with atorvastatin could be beneficial. OBJECTIVES Primary objective To quantify the magnitude of the effect of atorvastatin on total testosterone in both males and females, compared to placebo or no treatment. Secondary objectives To quantify the magnitude of the effects of atorvastatin on free testosterone, sex hormone binding globin (SHBG), androstenedione, dehydroepiandrosterone sulphate (DHEAS) concentrations, free androgen index (FAI), and withdrawal due to adverse effects (WDAEs) in both males and females, compared to placebo or no treatment. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCTs) up to 9 November 2020: the Cochrane Hypertension Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; ;two international trials registries, and the websites of the US Food and Drug Administration, the European Patent Office and the Pfizer pharmaceutical corporation. These searches had no language restrictions. We also contacted authors of relevant articles regarding further published and unpublished work. SELECTION CRITERIA RCTs of daily atorvastatin for at least three weeks, compared with placebo or no treatment, and assessing change in testosterone levels in males or females. DATA COLLECTION AND ANALYSIS Two review authors independently screened the citations, extracted the data and assessed the risk of bias of the included studies. We used the mean difference (MD) with associated 95% confidence intervals (CI) to report the effect size of continuous outcomes,and the risk ratio (RR) to report effect sizes of the sole dichotomous outcome (WDAEs). We used a fixed-effect meta-analytic model to combine effect estimates across studies, and risk ratio to report effect size of the dichotomous outcomes. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included six RCTs involving 265 participants who completed the study and their data was reported. Participants in two of the studies were male with normal lipid profile or mild dyslipidaemia (N = 140); the mean age of participants was 68 years. Participants in four of the studies were female with PCOS (N = 125); the mean age of participants was 32 years. We found no significant difference in testosterone levels in males between atorvastatin and placebo, MD -0.20 nmol/L (95% CI -0.77 to 0.37). In females, atorvastatin may reduce total testosterone by -0.27 nmol/L (95% CI -0.50 to -0.04), FAI by -2.59 nmol/L (95% CI -3.62 to -1.57), androstenedione by -1.37 nmol/L (95% CI -2.26 to -0.49), and DHEAS by -0.63 μmol/l (95% CI -1.12 to -0.15). Furthermore, compared to placebo, atorvastatin increased SHBG concentrations in females by 3.11 nmol/L (95% CI 0.23 to 5.99). We identified no studies in healthy females (i.e. females with normal testosterone levels) or children (under age 18). Importantly, no study reported on free testosterone levels. AUTHORS' CONCLUSIONS We found no significant difference between atorvastatin and placebo on the levels of total testosterone in males. In females with PCOS, atorvastatin lowered the total testosterone, FAI, androstenedione, and DHEAS. The certainty of evidence ranged from low to very low for both comparisons. More RCTs studying the effect of atorvastatin on testosterone are needed.
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Affiliation(s)
- Muhammad Ismail Shawish
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Bahador Bagheri
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Vijaya M Musini
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Stephen P Adams
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - James M Wright
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
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8
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Carlisle MA, Fudim M, DeVore AD, Piccini JP. Heart Failure and Atrial Fibrillation, Like Fire and Fury. JACC-HEART FAILURE 2020; 7:447-456. [PMID: 31146871 DOI: 10.1016/j.jchf.2019.03.005] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
Heart failure and atrial fibrillation are 2 common cardiovascular disorders that frequently complicate one another and exert a significant detrimental effect on cardiovascular health and well-being. Both heart failure and atrial fibrillation continue to increase in prevalence as the risk factors underlying each condition become more common. This review encompasses what is currently known about the epidemiology and pathophysiology of these comorbidities along with incorporation of landmark trials that have contributed to current guidelines. The focus is on clinically relevant considerations, including the contribution of inflammation in the pathophysiology of atrial fibrillation and heart failure. We explore the emerging role of catheter ablation relative to medical therapy in the management of heart failure with reduced ejection fraction, along with indications for biventricular pacing modalities in cardiac resynchronization therapy. We discuss current guideline-directed therapies and how practice models and national recommendations will likely change based on the most recent randomized controlled trials.
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Affiliation(s)
- Matthew A Carlisle
- Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marat Fudim
- Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Adam D DeVore
- Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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9
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Oesterle A, Liao JK. The Pleiotropic Effects of Statins - From Coronary Artery Disease and Stroke to Atrial Fibrillation and Ventricular Tachyarrhythmia. Curr Vasc Pharmacol 2020; 17:222-232. [PMID: 30124154 DOI: 10.2174/1570161116666180817155058] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/06/2018] [Accepted: 06/06/2018] [Indexed: 12/11/2022]
Abstract
Statins, 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, have been used for decades for the prevention of coronary artery disease and stroke. They act primarily by lowering serum cholesterol through the inhibition of cholesterol synthesis in the liver, which results in the upregulation of low-density lipoprotein receptors in the liver. This results in the removal of low-density lipoproteincholesterol. Studies have suggested that statins may demonstrate additional effects that are independent of their effects on low-density lipoprotein-cholesterol. These have been termed "pleiotropic" effects. Pleiotropic effects may be due to the inhibition of isoprenoid intermediates by statins. Isoprenoid inhibition has effects on the small guanosine triphosphate binding proteins Rac and Rho which in turn effects nicotinamide adenine dinucleotide phosphate oxidases. Therefore, there are changes in endothelial nitric oxide synthase expression, atherosclerotic plaque stability, pro-inflammatory cytokines and reactive oxygen species production, platelet reactivity, and cardiac fibrosis and hypetrophy development. Recently, statins have been compared to the ezetimibe and the recently published outcomes data on the proprotein convertase subtilisin kexin type 9 inhibitors has allowed for a reexamination of statin pleiotropy. As a result of these diverse effects, it has been suggested that statins also have anti-arrhythmic effects. This review focuses on the mechanisms of statin pleiotropy and discusses evidence from the statin clinical trials as well as examining the possible anti-arrhythmic effects atrial fibrillation and ventricular tachyarrhythmias.
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Affiliation(s)
- Adam Oesterle
- The Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, IL 60637, United States
| | - James K Liao
- The Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, IL 60637, United States
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10
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Tsiachris D, Giannopoulos G, Deftereos S, Kossyvakis C, Tsioufis C, Siasos G, Oikonomou E, Gatzoulis K, Tousoulis D, Stefanadis C. Biomarkers Determining Prognosis of Atrial Fibrillation Ablation. Curr Med Chem 2019; 26:925-937. [DOI: 10.2174/0929867325666180320122930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/22/2022]
Abstract
Catheter ablation for rhythm control is recommended in specific patient populations
with paroxysmal, persistent, or long-standing persistent atrial fibrillation. Pulmonary
vein isolation is the cornerstone of the ablative therapy for atrial fibrillation. However, relapse
is still common since the single procedure efficacy of atrial fibrillation ablation was estimated
to be 60-80% in paroxysmal and 50-70% in persistent atrial fibrillation. It is important to
identify predictors of successful atrial fibrillation patients ablation. In the present review, we
will assess the role of available biomarkers to predict responders of an initial atrial fibrillation
catheter ablation. Emphasis has been given on the role of myocardial injury biomarkers, natriuretic
peptides and traditional inflammatory markers. Novel inflammatory markers, oxidative
stress biomarkers and microRNAs have also been examined as predictors of a successful atrial
fibrillation procedure. Notably, the impact of procedural and short-term administration of
steroids, as well as the role of colchicine on preventing atrial fibrillation recurrence after ablation
is thoroughly presented.
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Affiliation(s)
| | | | - Spyridon Deftereos
- 2nd Department of Cardiology, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Kossyvakis
- Department of Cardiology, 'Georgios Genimmatas' General Hospital of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece
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11
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van 't Erve TJ. Strategies to decrease oxidative stress biomarker levels in human medical conditions: A meta-analysis on 8-iso-prostaglandin F 2α. Redox Biol 2018; 17:284-296. [PMID: 29775960 PMCID: PMC6007822 DOI: 10.1016/j.redox.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023] Open
Abstract
The widespread detection of elevated oxidative stress levels in many medical conditions has led to numerous efforts to design interventions to reduce its effects. Efforts have been wide-ranging, from dietary changes to administration of antioxidants, supplements, e.g., omega-3-fatty acids, and many medications. However, there is still no systemic assessment of the efficacy of treatments for oxidative stress reduction across a variety of medical conditions. The goal of this meta-analysis is, by combining multiple studies, to quantitate the change in the levels of the popular oxidative stress biomarker 8-iso-prostaglandin F2α (8-iso-PGF2α) after a variety of treatment strategies in human populations. Nearly 350 unique publications with 180 distinct strategies were included in the analysis. For each strategy, the difference between pre- or placebo and post-treatment levels calculated using Hedges' g value of effect. In general, administration of antibiotics, antihyperlipidemic agents, or changes in lifestyle (g = - 0.63, - 0.54, and 0.56) had the largest effect. Administration of supplements, antioxidants, or changes in diet (g = - 0.09, - 0.28, - 0.12) had small quantitative effects. To fully interpret the effectiveness of these treatments, comparisons to the increase in g value for each medical condition is required. For example, antioxidants in populations with coronary artery disease (CAD) reduce the 8-iso-PGF2α levels by g = - 0.34 ± 0.1, which is quantitatively considered a small effect. However, CAD populations, in comparison to healthy populations, have an increase in 8-iso-PGF2α levels by g = 0.38 ± 0.04; therefore, the overall reduction of 8-iso-PGF2α levels is ≈ 90% by this treatment in this specific medical condition. In conclusion, 8-iso-PGF2α levels can be reduced not only by antioxidants but by many other strategies. Not all strategies are equally effective at reducing 8-iso-PGF2α levels. In addition, the effectiveness of any strategy can be assessed only in relation to the medical condition investigated.
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Affiliation(s)
- Thomas J van 't Erve
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, 27709 NC, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, 27709 NC, USA.
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12
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He Y, Chen X, Guo X, Yin H, Ma N, Tang M, Liu H, Mei J. Th17/Treg Ratio in Serum Predicts Onset of Postoperative Atrial Fibrillation After Off-Pump Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2017; 27:1467-1475. [PMID: 28993118 DOI: 10.1016/j.hlc.2017.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/31/2017] [Accepted: 08/07/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this study is to identify whether the balance between T helper 17 (Th17) cells and CD4+CD25+Foxp3+ regulatory T (Treg) cells could predict the postoperative atrial fibrillation (POAF) after coronary artery bypass graft surgery (CABG). METHODS We enrolled 88 patients from Xinhua Hospital who received off-pump CABG (OPCABG) surgery. The baseline characteristics of patients were recorded. The preoperative variables C-reactive protein (CRP) level, left atrial (LA) volume, EuroSCORE I score, CHADS2 score, and CHA2DS2-VASc score were calculated at enrolment. Circulating Th17 and Treg cell frequencies were determined by flow cytometry, and expressions of Th17- and Treg-related cytokines were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Compared to patients without POAF, the CRP level and peripheral circulating Th17 cell were significantly increased in POAF patients. Th17/Treg ratio was positively correlated with CRP level, LA volume, CHADS2 score, and CHA2DS2-VASc score. The areas under the receiver-operating characteristic (AUC) curves of Th17/Treg ratio for predicting POAF occurrence was higher than that of CRP level, LA volume, CHADS2 score and CHA2DS2-VASc score. Th17/Treg ratio combined with CRP level has the highest AUC and a greater balance between sensitivity and specificity for predicting POAF. CONCLUSIONS Our data suggest that a Th17/Treg imbalance due to a Th17 shift, representing a pro-inflammatory tendency, participates in the development of POAF. Combining the Th17/Treg ratio with CRP level may provide a more accurate, sensitive, and specific indicator for prediction of POAF.
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Affiliation(s)
- Yi He
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xi Chen
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xuejun Guo
- Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hang Yin
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nan Ma
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min Tang
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hao Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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13
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Meta-analysis Identifies Serum C-Reactive Protein as an Indicator of Atrial Fibrillation Risk After Coronary Artery Bypass Graft. Am J Ther 2017; 23:e1586-e1596. [PMID: 25901664 DOI: 10.1097/mjt.0000000000000255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A meta-analysis-based study was conducted to examine the clinical value of serum C-reactive protein (CRP) levels in predicting postoperative atrial fibrillation (POAF) in patients with coronary artery disease (CAD) who underwent coronary artery bypass graft. Computer-based search of scientific literature databases was performed to identify relevant studies in strict accordance with our inclusion and exclusion criteria. Data extracted from the selected studies were used to perform meta-analysis using the STATA 12.0 statistical software. Standardized mean differences (SMDs) with their 95% confidence interval (95% CI) were calculated. The database search strategy initially identified 62 articles (Chinese = 17, English = 45). After multiple levels of screening and validation, 15 case-control studies (Chinese = 1, English = 14), containing of a total of 3110 atrial fibrillation patients (POAF = 925, non-POAF = 2185), were selected for our meta-analysis. The meta-analysis results confirmed that serum CRP level was remarkably higher in patients with POAF compared with non-POAF (SMD = 1.36; 95% CI, 0.44-2.28; P = 0.004). Ethnicity-stratified analysis revealed that elevated serum CRP levels were associated with an increased risk of POAF in white patients with CAD (SMD = 0.85; 95% CI, 0.12-1.58; P = 0.022), but not Asian patients with CAD (SMD = 3.31, 95% CI, -0.04 to 6.66; P = 0.053). Elevated CRP levels, indicating profound inflammation, may be associated with significantly increased risk of POAF in patients with CAD who underwent coronary artery bypass graft. Thus, serum CRP levels are important for early diagnosis and monitoring of POAF in high-risk patients.
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14
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The electrical heart: 25 years of discovery in cardiac electrophysiology, arrhythmias and sudden death. Cardiovasc Pathol 2016; 25:149-57. [DOI: 10.1016/j.carpath.2015.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 12/16/2022] Open
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15
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Simon JN, Ziberna K, Casadei B. Compromised redox homeostasis, altered nitroso-redox balance, and therapeutic possibilities in atrial fibrillation. Cardiovasc Res 2016; 109:510-8. [PMID: 26786158 PMCID: PMC4777914 DOI: 10.1093/cvr/cvw012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/15/2016] [Indexed: 12/31/2022] Open
Abstract
Although the initiation, development, and maintenance of atrial fibrillation (AF) have been linked to alterations in myocyte redox state, the field lacks a complete understanding of the impact these changes may have on cellular signalling, atrial electrophysiology, and disease progression. Recent studies demonstrate spatiotemporal changes in reactive oxygen species production shortly after the induction of AF in animal models with an uncoupling of nitric oxide synthase activity ensuing in the presence of long-standing persistent AF, ultimately leading to a major shift in nitroso–redox balance. However, it remains unclear which radical or non-radical species are primarily involved in the underlying mechanisms of AF or which proteins are targeted for redox modification. In most instances, only free radical oxygen species have been assessed; yet evidence from the redox signalling field suggests that non-radical species are more likely to regulate cellular processes. A wider appreciation for the distinction of these species and how both species may be involved in the development and maintenance of AF could impact treatment strategies. In this review, we summarize how redox second-messenger systems are regulated and discuss the recent evidence for alterations in redox regulation in the atrial myocardium in the presence of AF, while identifying some critical missing links. We also examine studies looking at antioxidants for the prevention and treatment of AF and propose alternative redox targets that may serve as superior therapeutic options for the treatment of AF.
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Affiliation(s)
- Jillian N Simon
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Klemen Ziberna
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Pokorney SD, Piccini JP. Calcified Pipes: You Better Call the Electrician Too. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.004202. [PMID: 26659369 DOI: 10.1161/circimaging.115.004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sean D Pokorney
- From the Electrophysiology Section, Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC
| | - Jonathan P Piccini
- From the Electrophysiology Section, Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC.
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Statin therapy lowers the risk of new-onset atrial fibrillation in patients with end-stage renal disease. Int J Cardiol 2015; 201:538-43. [DOI: 10.1016/j.ijcard.2015.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/08/2015] [Accepted: 01/25/2015] [Indexed: 11/20/2022]
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18
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Goldberger JJ, Arora R, Green D, Greenland P, Lee DC, Lloyd-Jones DM, Markl M, Ng J, Shah SJ. Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate. Circulation 2015. [PMID: 26216085 DOI: 10.1161/circulationaha.115.016795] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial disease or myopathy forms the substrate for atrial fibrillation (AF) and underlies the potential for atrial thrombus formation and subsequent stroke. Current diagnostic approaches in patients with AF focus on identifying clinical predictors with the evaluation of left atrial size by echocardiography serving as the sole measure specifically evaluating the atrium. Although the atrial substrate underlying AF is likely developing for years before the onset of AF, there is no current evaluation to identify the preclinical atrial myopathy. Atrial fibrosis is 1 component of the atrial substrate that has garnered recent attention based on newer MRI techniques that have been applied to visualize atrial fibrosis in humans with prognostic implications regarding the success of treatment. Advanced ECG signal processing, echocardiographic techniques, and MRI imaging of fibrosis and flow provide up-to-date approaches to evaluate the atrial myopathy underlying AF. Although thromboembolic risk is currently defined by clinical scores, their predictive value is mediocre. Evaluation of stasis via imaging and biomarkers associated with thrombogenesis may provide enhanced approaches to assess risk for stroke in patients with AF. Better delineation of the atrial myopathy that serves as the substrate for AF and thromboembolic complications might improve treatment outcomes. Furthermore, better delineation of the pathophysiologic mechanisms underlying the development of the atrial substrate for AF, particularly in its earlier stages, could help identify blood and imaging biomarkers that could be useful to assess risk for developing new-onset AF and suggest specific pathways that could be targeted for prevention.
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Affiliation(s)
- Jeffrey J Goldberger
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Rishi Arora
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Green
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Philip Greenland
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel C Lee
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Donald M Lloyd-Jones
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Markl
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jason Ng
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sanjiv J Shah
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
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19
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Qi WW, Liu T, Xu G, Li LF, Liang YZ, Ye L, Li GP. Upstream therapeutic strategies of Valsartan and Fluvastatin on Hypertensive patients with non-permanent Atrial Fibrillation (VF-HT-AF): study protocol for a randomized controlled trial. Trials 2015; 16:336. [PMID: 26248619 PMCID: PMC4528391 DOI: 10.1186/s13063-015-0836-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 07/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies regarding rhythm control in patients with atrial fibrillation (AF) could not sufficiently demonstrate the efficacy of available anti-arrhythmic drugs. 'Upstream therapy' has emerged as a potential strategy for the prevention and treatment of AF. The use of angiotensin II receptor blockers and statins has been suggested to decrease new-onset AF, but which remains inadequately explored. This study was designed to examine whether valsartan or fluvastatin can reduce the risk of non-permanent AF in patients with hypertension. METHODS/DESIGN The VF-HT-AF study is a multicenter, randomized, open-label, four-arm parallel group study with comparative evaluation of valsartan and fluvastatin as upstream therapies for the treatment of non-permanent AF complicated by hypertension. The primary outcome measure is change in the development of paroxysmal AF into persistent or permanent AF, the development of persistent AF to permanent AF, and change in incidence of overall and persistent AF recurrence, as evaluated by 7-days ambulatory electrocardiograph monitoring (Holter) and patients' diaries during 2 years' follow-up. Secondary outcome measures of this study include the occurrence of: (1) fatal and nonfatal myocardial infarction; (2) heart failure (New York Heart Association stage III or IV); (3) cardiogenic shock; (4) serious bleeding necessitating hospitalization; (5) malignant ventricular arrhythmia; (6) revascularization therapy; (7) radiofrequency catheter ablation of AF; (8) changes of left atrial dimension, as measured by ultrasound echocardiography; (9) stroke; (10) cardiovascular mortality; and (11) all-cause mortality. A total of 1879 patients will be investigated from 15 medical centers throughout China to obtain the relevant information. DISCUSSION This is the first study in hypertensive patients complicated non-permanent AF in the Chinese population. Results of this study will inform the use of upstream therapies of AF. TRIAL REGISTRATION chictr.org, ChiCTR-TRC-12002642.
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Affiliation(s)
- Wen-Wei Qi
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
| | - Gang Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
| | - Li-Feng Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
| | - Ying-Zi Liang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
| | - Lan Ye
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
| | - Guang-Ping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China.
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20
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Tsikas D, Pham VV, Suchy MT, van de Ree MA, Huisman MV, Frölich JC, Princen HM. No effects of atorvastatin (10mg/d or 80mg/d) on nitric oxide, prostacyclin, thromboxane and oxidative stress in type 2 diabetes mellitus patients of the DALI study. Pharmacol Res 2015; 94:1-8. [DOI: 10.1016/j.phrs.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 01/24/2023]
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21
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Abstract
BACKGROUND This represents the first update of this review, which was published in 2012. Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to know the dose-related magnitude of effect of atorvastatin on blood lipids. OBJECTIVES Primary objective To quantify the effects of various doses of atorvastatin on serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides in individuals with and without evidence of cardiovascular disease. The primary focus of this review was determination of the mean per cent change from baseline of LDL-cholesterol. Secondary objectives • To quantify the variability of effects of various doses of atorvastatin.• To quantify withdrawals due to adverse effects (WDAEs) in placebo-controlled randomised controlled trials (RCTs). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2013), MEDLINE (1966 to December Week 2 2013), EMBASE (1980 to December Week 2 2013), Web of Science (1899 to December Week 2 2013) and BIOSIS Previews (1969 to December Week 2 2013). We applied no language restrictions. SELECTION CRITERIA Randomised controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on blood lipids over a duration of three to 12 weeks. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility criteria for studies to be included and extracted data. We collected information on withdrawals due to adverse effects from placebo-controlled trials. MAIN RESULTS In this update, we found an additional 42 trials and added them to the original 254 studies. The update consists of 296 trials that evaluated dose-related efficacy of atorvastatin in 38,817 participants. Included are 242 before-and-after trials and 54 placebo-controlled RCTs. Log dose-response data from both trial designs revealed linear dose-related effects on blood total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. The Summary of findings table 1 documents the effect of atorvastatin on LDL-cholesterol over the dose range of 10 to 80 mg/d, which is the range for which this systematic review acquired the greatest quantity of data. Over this range, blood LDL-cholesterol is decreased by 37.1% to 51.7% (Summary of findings table 1). The slope of dose-related effects on cholesterol and LDL-cholesterol was similar for atorvastatin and rosuvastatin, but rosuvastatin is about three-fold more potent. Subgroup analyses suggested that the atorvastatin effect was greater in females than in males and was greater in non-familial than in familial hypercholesterolaemia. Risk of bias for the outcome of withdrawals due to adverse effects (WDAEs) was high, but the mostly unclear risk of bias was judged unlikely to affect lipid measurements. Withdrawals due to adverse effects were not statistically significantly different between atorvastatin and placebo groups in these short-term trials (risk ratio 0.98, 95% confidence interval 0.68 to 1.40). AUTHORS' CONCLUSIONS This update resulted in no change to the main conclusions of the review but significantly increases the strength of the evidence. Studies show that atorvastatin decreases blood total cholesterol and LDL-cholesterol in a linear dose-related manner over the commonly prescribed dose range. New findings include that atorvastatin is more than three-fold less potent than rosuvastatin, and that the cholesterol-lowering effects of atorvastatin are greater in females than in males and greater in non-familial than in familial hypercholesterolaemia. This review update does not provide a good estimate of the incidence of harms associated with atorvastatin because included trials were of short duration and adverse effects were not reported in 37% of placebo-controlled trials.
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Affiliation(s)
- Stephen P Adams
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
| | - Michael Tsang
- McMaster UniversityDepartment of Internal Medicine, Internal Medicine Residency Office, Faculty of Medicine1200 Main Street WestHSC 3W10HamiltonONCanadaL8N 3N5
| | - James M Wright
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
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Jalife J, Kaur K. Atrial remodeling, fibrosis, and atrial fibrillation. Trends Cardiovasc Med 2014; 25:475-84. [PMID: 25661032 DOI: 10.1016/j.tcm.2014.12.015] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/25/2014] [Accepted: 12/26/2014] [Indexed: 01/08/2023]
Abstract
The fundamental mechanisms governing the perpetuation of atrial fibrillation (AF), the most common arrhythmia seen in clinical practice, are poorly understood, which explains in part why AF prevention and treatment remain suboptimal. Although some clinical parameters have been identified as predicting a transition from paroxysmal to persistent AF in some patients, the molecular, electrophysiological, and inflammation changes leading to such a progression have not been described in detail. Oxidative stress, atrial dilatation, calcium overload, inflammation, microRNAs, and myofibroblast activation are all thought to be involved in AF-induced atrial remodeling. However, it is unknown to what extent and at which time points such alterations influence the remodeling process that perpetuates AF. Here we postulate a working model that might open new pathways for future investigation into mechanisms of AF perpetuation. We start from the premise that the progression to AF perpetuation is the result of interplay among manifold signaling pathways with differing kinetics. Some such pathways have relatively fast kinetics (e.g., oxidative stress-mediated shortening of refractory period); others likely depend on molecular processes with slower kinetics (e.g., transcriptional changes in myocyte ion channel protein expression mediated through inflammation and fibroblast activation). We stress the need to fully understand the relationships among such pathways should one hope to identify novel, truly effective targets for AF therapy and prevention.
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Affiliation(s)
- José Jalife
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI.
| | - Kuljeet Kaur
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI
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23
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Yan P, Dong P, Li Z, Cheng J. Statin therapy decreased the recurrence frequency of atrial fibrillation after electrical cardioversion: a meta-analysis. Med Sci Monit 2014; 20:2753-8. [PMID: 25529758 PMCID: PMC4280056 DOI: 10.12659/msm.891049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background It is unclear whether statin agents provide clinical benefit in preventing the relapse of atrial fibrillation (AF) after electrical cardioversion (EC). The purpose of this study was to assess the effect of statin agents on the recurrence of AF after EC by conducting a meta-analysis of randomized controlled trials (RCTs). Material/Methods We conducted a systematic literature search of Medline, EMBASE, ISI Web of Science, and Cochrane databases. RCTs comparing clinical endpoint of the recurrence of AF associated with statin administration vs. no statin treatment (placebo or conventional medical therapy) in patients with AF after EC were eligible. Combined results are presented as risk ratios (RRs) with 95% confidence intervals (CIs). Results A total of 5 trials with 524 patients were available for analysis. The pooling analysis showed that statin agents significantly reduced the recurrence of AF after EC compared with no statin treatment (RR=0.76, 95% CI 0.63–0.92; p=0.004; I2=44%). The beneficial effect was shown both in AF subjects receiving atorvastatin or rosuvastatin treatment (atorvastatin 80 mg: RR=0.82, p=0.05; atorvastatin 10 mg: RR=0.27, p=0.03; rosuvastatin: RR=0.38, p=0.04) and in younger patients (<65 years; RR=0.58, p=0.0005). Furthermore, the benefit of statin agents on preventing AF recurrence after EC was demonstrated within 3-month follow-up (p=0.03), and the clinical benefit seemed likely to remain until no less than 12 months after EC (p=0.05). Conclusions Based on the currently available data, administration of statin agents, especially atorvastatin or rosuvastatin, is beneficial in lowering the frequency of AF recurrence after EC.
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Affiliation(s)
- Peng Yan
- Department of Cardiology, First Affiliated Hospital, Henan Science and Technology University, Luoyang, Henan, China (mainland)
| | - Pingshuan Dong
- Department of Cardiology, First Affiliated Hospital, Henan Science and Technology University, Luoyang, Henan, China (mainland)
| | - Zhijuan Li
- Department of Cardiology, First Affiliated Hospital, Henan Science and Technology University, Luoyang, Henan, China (mainland)
| | - Jianxin Cheng
- Department of Cardiology, First Affiliated Hospital, Henan Science and Technology University, Luoyang, Henan, China (mainland)
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Yang Q, Qi X, Li Y. The preventive effect of atorvastatin on atrial fibrillation: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2014; 14:99. [PMID: 25117689 PMCID: PMC4135360 DOI: 10.1186/1471-2261-14-99] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/04/2014] [Indexed: 11/12/2022] Open
Abstract
Background A number of clinical and experimental studies have investigated the effect of atorvastatin on atrial fibrillation (AF), but the results are equivocal. This meta-analysis was performed to evaluate whether atorvastatin can reduce the risk of AF in different populations. Methods We searched PubMed, EMBASE and the Cochrane Database for all published studies that examined the effect of atorvastatin therapy on AF up to April 2014. A random effects model was used when there was substantial heterogeneity and a fixed effects model when there was negligible heterogeneity. Results Eighteen published studies including 9952 patients with sinus rhythm were identified for inclusion in the analysis. Ten studies investigated primary prevention of AF by atorvastatin in patients without AF, seven studies investigated secondary prevention of atorvastatin in patients with AF, and one study investigated mixed populations of patients. Overall, atorvastatin was associated with a decreased risk of AF (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.36–0.70, P < 0.0001). However, subgroup analyses showed that in the primary prevention subgroup (OR 0.55, 95% CI 0.38–0.81, P = 0.002), atorvastatin reduced the risk of new-onset AF in patients after coronary surgery (OR 0.44, 95% CI 0.29–0.68, P = 0.0002), but had no beneficial effect in patients without coronary surgery (OR 0.97, 95% CI 0.59–1.58, P = 0.89); in the secondary prevention subgroup, atorvastatin had no beneficial effect on AF recurrence in patients with electrical cardioversion (EC) (OR 0.57, 95% CI 0.25–1.32, P = 0.19) or without EC (OR 0.38, 95% CI 0.14–1.06, P = 0.06). Conclusions This meta-analysis suggests that atorvastatin has an overall protective effect against AF. However, this preventive effect was not seen in all types of AF. Atorvastatin was significantly associated with a decreased risk of new-onset AF in patients after coronary surgery. Moreover, atorvastatin did not prove to exert a significant protective effect against the AF recurrences in both patients who had experienced sinus rhythm restoration by means of EC and those who had obtained cardioversion by means of drug therapy. Thus, further prospective studies are warranted.
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Affiliation(s)
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.
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Gonna H, Gallagher MM. The efficacy and tolerability of commonly used agents to prevent recurrence of atrial fibrillation after successful cardioversion. Am J Cardiovasc Drugs 2014; 14:241-51. [PMID: 24604773 DOI: 10.1007/s40256-014-0064-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A number of therapeutic strategies exist for the restoration and maintenance of sinus rhythm in patients presenting with atrial fibrillation. The acute success rate with electrical cardioversion is high. However, many patients relapse into atrial fibrillation. A major challenge faced by those who care for patients with atrial fibrillation is the long-term maintenance of sinus rhythm whilst avoiding treatment-related adverse effects. This review examines the efficacy and tolerability of conventional anti-arrhythmic drugs for the secondary prevention of atrial fibrillation in the post-cardioversion period.
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Affiliation(s)
- Hanney Gonna
- Department of Cardiology, St. George's Hospital, Blackshaw Rd, SW17 0QT, London, UK
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Mihos CG, Pineda AM, Santana O. Cardiovascular effects of statins, beyond lipid-lowering properties. Pharmacol Res 2014; 88:12-9. [PMID: 24631782 DOI: 10.1016/j.phrs.2014.02.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 12/11/2022]
Abstract
The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, better known as 'statins', are amongst the most widely used medications in the world. They have become a pivotal component in the primary and secondary prevention of coronary artery and vascular disease. However, a growing amount of evidence has suggested that statins also possess strong pleiotropic effects irrespective of their lipid-lowering properties, which include enhancement of endothelial function, anti-inflammatory and anti-atherothrombotic properties, and immunomodulation. The following provides a comprehensive and updated review of the clinical evidence regarding the pleiotropic effects of statins in cardiovascular disorders and their potential therapeutic benefits.
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Affiliation(s)
- Christos G Mihos
- Columbia University, Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL, United States
| | - Andres M Pineda
- Columbia University, Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL, United States
| | - Orlando Santana
- Columbia University, Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL, United States.
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Hermida N, Balligand JL. Low-density lipoprotein-cholesterol-induced endothelial dysfunction and oxidative stress: the role of statins. Antioxid Redox Signal 2014; 20:1216-37. [PMID: 23924077 DOI: 10.1089/ars.2013.5537] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
SIGNIFICANCE Cardiovascular diseases (CVD) represent a major public health burden. High low-density lipoprotein (LDL)-cholesterol is a recognized pathogenic factor for atherosclerosis, and its complications and statins represent the most potent and widely used therapeutic approach to prevent and control these disorders. RECENT ADVANCES A number of clinical and experimental studies concur to identify endothelial dysfunction as a primary step in the development of atherosclerosis, as well as a risk factor for subsequent clinical events. Oxidant stress resulting from chronic elevation of plasma LDL-cholesterol (LDL-chol) is a major contributor to both endothelial dysfunction and its complications, for example, through alterations of endothelial nitric oxide signaling. CRITICAL ISSUES Statin treatment reduces morbidity and mortality of CVD, but increasing evidence questions that this is exclusively through reduction of plasma LDL-chol. The identification of ancillary effects on (cardio)vascular biology, for example, through their modulation of oxidative stress, will not only increase our understanding of their mechanisms of action, with a potential broadening of their indication(s), but also lead to the identification of new molecular targets for future therapeutic developments in CVD. FUTURE DIRECTIONS Further characterization of molecular pathways targeted by statins, for example, not directly mediated by changes in plasma lipid concentrations, should enable a more comprehensive approach to the pathogenesis of (cardio)vascular disease, including, for example, epigenetic regulation and fine tuning of cell metabolism.
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Affiliation(s)
- Nerea Hermida
- 1 Pole of Pharmacology and Therapeutics (FATH), Institut de Recherche Experimentale et Clinique (IREC), Université catholique de Louvain , Brussels, Belgium
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Kimura T, Takatsuki S, Inagawa K, Katsumata Y, Nishiyama T, Nishiyama N, Fukumoto K, Aizawa Y, Tanimoto Y, Tanimoto K, Fukuda K. Serum inflammation markers predicting successful initial catheter ablation for atrial fibrillation. Heart Lung Circ 2014; 23:636-43. [PMID: 24613042 DOI: 10.1016/j.hlc.2014.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/26/2013] [Accepted: 02/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated various serum inflammatory markers to predict ablation responders who have no atrial fibrillation (AF) relapse after the initial ablation. METHODS Forty-four consecutive AF patients (age: 59 ± 8 years, paroxysmal: 31, CHADS₂: 1.1 ± 1.1) who underwent an initial pulmonary vein isolation were investigated. Various serum inflammatory markers, such as adiponectin, ANP, BNP, 1CTP, F1+2, hs-CRP, IL-6, intact P1NP, MDA-LDL, MMP-2, TGF-β, TIMP-2, and TNF-α, were evaluated prior to ablation. AF relapse was defined as AF documented in telemonitoring electrocardiograms twice a day during 9.7 ± 2.4 months of follow-up with three months of a blanking-period. RESULTS A total of 29 patients (paroxysmal: 21) maintained sinus rhythm after the initial catheter ablation. These ablation responders had significantly lower MMP-2 (Sinus vs. Relapsed: 748 ± 132.7 vs. 841.2 ± 152.4 ng/mL, P=0.042) and TNF-α (1.1 ± 0.4 vs. 1.8 ± 1.7 pg/mL, P=0.046) levels prior to ablation. A BNP-adjusted Cox multivariate regression analysis revealed that the independent predictive factor for AF recurrence was high MMP-2 levels (>766 ng/mL) accompanied by high TNF-α levels (>1.2 pg/mL). CONCLUSIONS The levels of MMP-2 and TNF-α might be useful for predicting initial AF catheter ablation responders.
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Affiliation(s)
- Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN.
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Kohei Inagawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | | | - Takahiko Nishiyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Nobuhiro Nishiyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Kotaro Fukumoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Yoko Tanimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Kojiro Tanimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, JAPAN
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Lappegård KT, Hovland A, Pop GAM, Mollnes TE. Atrial fibrillation: inflammation in disguise? Scand J Immunol 2013; 78:112-9. [PMID: 23672430 DOI: 10.1111/sji.12061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/03/2013] [Indexed: 02/03/2023]
Abstract
Atrial fibrillation is highly prevalent, and affected patients are at an increased risk of a number of complications, including heart failure and thrombo-embolism. Over the past years, there has been increasing interest in the role of inflammatory processes in atrial fibrillation, from the first occurrence of the arrhythmia to dreaded complications such as strokes or peripheral emboli. As the standard drug combination which aims at rate control and anticoagulation only offers partial protection against complications, newer agents are needed to optimize treatment. In this paper, we review recent knowledge regarding the impact of inflammation on the occurrence, recurrence, perpetuation and complications of the arrhythmia, as well as the role of anti-inflammatory therapies in the treatment for the disease.
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Affiliation(s)
- K T Lappegård
- Coronary Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.
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Affiliation(s)
- Kai-Chien Yang
- Lifespan Cardiovascular Institute, the Warren Alpert School of Medicine, Brown University, and the Providence Veterans Administration Medical Center, Providence, RI
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Purohit A, Rokita AG, Guan X, Chen B, Koval OM, Voigt N, Neef S, Sowa T, Gao Z, Luczak ED, Stefansdottir H, Behunin AC, Li N, El-Accaoui RN, Yang B, Swaminathan PD, Weiss RM, Wehrens XHT, Song LS, Dobrev D, Maier LS, Anderson ME. Oxidized Ca(2+)/calmodulin-dependent protein kinase II triggers atrial fibrillation. Circulation 2013; 128:1748-57. [PMID: 24030498 DOI: 10.1161/circulationaha.113.003313] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing public health problem without adequate therapies. Angiotensin II and reactive oxygen species are validated risk factors for AF in patients, but the molecular pathways connecting reactive oxygen species and AF are unknown. The Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) has recently emerged as a reactive oxygen species-activated proarrhythmic signal, so we hypothesized that oxidized CaMKIIδ could contribute to AF. METHODS AND RESULTS We found that oxidized CaMKII was increased in atria from AF patients compared with patients in sinus rhythm and from mice infused with angiotensin II compared with mice infused with saline. Angiotensin II-treated mice had increased susceptibility to AF compared with saline-treated wild-type mice, establishing angiotensin II as a risk factor for AF in mice. Knock-in mice lacking critical oxidation sites in CaMKIIδ (MM-VV) and mice with myocardium-restricted transgenic overexpression of methionine sulfoxide reductase A, an enzyme that reduces oxidized CaMKII, were resistant to AF induction after angiotensin II infusion. CONCLUSIONS Our studies suggest that CaMKII is a molecular signal that couples increased reactive oxygen species with AF and that therapeutic strategies to decrease oxidized CaMKII may prevent or reduce AF.
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Affiliation(s)
- Anil Purohit
- Department of Internal Medicine, Division of Cardiovascular Medicine and Cardiovascular Research Center, Carver College of Medicine (A.P., A.G.R., X.G., B.C., O.M.K., Z.G., E.D.L., H.S., A.C.B., R.N.E.-A., P.D.S., R.M.W., L.-S.S., M.E.A.), Department of Obstetrics and Gynecology (B.Y.), and Department of Molecular Physiology and Biophysics (M.E.A.), University of Iowa, Iowa City; Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany, and Division of Experimental Cardiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany (N.V., D.D.); Cardiology and Pneumology, German Heart Center, University Hospital Goettingen, Goettingen, Germany (S.N., T.S., L.S.M.); and Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX (N.L., X.H.T.W.)
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Hung CY, Lin CH, Wang KY, Huang JL, Hsieh YC, Loh EW, Lan TH, Chou P, Ting CT, Wu TJ. Dosage of statin, cardiovascular comorbidities, and risk of atrial fibrillation: A nationwide population-based cohort study. Int J Cardiol 2013; 168:1131-6. [DOI: 10.1016/j.ijcard.2012.11.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/09/2012] [Accepted: 11/11/2012] [Indexed: 12/19/2022]
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Alings M, Smit MD, Moes ML, Crijns HJGM, Tijssen JGP, Brügemann J, Hillege HL, Lane DA, Lip GYH, Smeets JRLM, Tieleman RG, Tukkie R, Willems FF, Vermond RA, Van Veldhuisen DJ, Van Gelder IC. Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure: background, aims and design of the RACE 3 study. Neth Heart J 2013; 21:354-63. [PMID: 23700039 PMCID: PMC3722377 DOI: 10.1007/s12471-013-0428-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Rhythm control for atrial fibrillation (AF) is cumbersome because of its progressive nature caused by structural remodelling. Upstream therapy refers to therapeutic interventions aiming to modify the atrial substrate, leading to prevention of AF. Objective The Routine versus Aggressive upstream rhythm Control for prevention of Early AF in heart failure (RACE 3) study hypothesises that aggressive upstream rhythm control increases persistence of sinus rhythm compared with conventional rhythm control in patients with early AF and mild-to-moderate early systolic or diastolic heart failure undergoing electrical cardioversion. Design RACE 3 is a prospective, randomised, open, multinational, multicenter trial. Upstream rhythm control consists of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, mineralocorticoid receptor antagonists, statins, cardiac rehabilitation therapy, and intensive counselling on dietary restrictions, exercise maintenance, and drug adherence. Conventional rhythm control consists of routine rhythm control therapy without cardiac rehabilitation therapy and intensive counselling. In both arms, every effort is made to keep patients in the rhythm control strategy, and ion channel antiarrhythmic drugs or pulmonary vein ablation may be instituted if AF relapses. Total inclusion will be 250 patients. If upstream therapy proves to be effective in improving maintenance of sinus rhythm, it could become a new approach to rhythm control supporting conventional pharmacological and non-pharmacological rhythm control.
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Affiliation(s)
- M. Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - M. D. Smit
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - M. L. Moes
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - H. J. G. M. Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J. G. P. Tijssen
- Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - J. Brügemann
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
- Cardiac Rehabilitation Center, University Medical Center Groningen, Groningen, the Netherlands
| | - H. L. Hillege
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
- Trial Coordination Center, Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - D. A. Lane
- University of Birmingham Center for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - G. Y. H. Lip
- University of Birmingham Center for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - J. R. L. M. Smeets
- Department of Cardiology, University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - R. G. Tieleman
- Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands
| | - R. Tukkie
- Department of Cardiology, Kennemer Gasthuis, Haarlem, the Netherlands
| | - F. F. Willems
- Department of Cardiology, Rijnstate Hospital, Arnhem/Velp, the Netherlands
| | - R. A. Vermond
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - D. J. Van Veldhuisen
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - I. C. Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
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Abstract
BACKGROUND Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to know the dose-related magnitude of effect of atorvastatin on blood lipids. OBJECTIVES To quantify the dose-related effects of atorvastatin on blood lipids and withdrawals due to adverse effects (WDAE). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 4, 2011, MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), ISI Web of Science (1899 to November 2011) and BIOSIS Previews (1969 to November 2011). No language restrictions were applied. SELECTION CRITERIA Randomised controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on blood lipids over a duration of 3 to 12 weeks. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. WDAE information was collected from the placebo-controlled trials. MAIN RESULTS Two hundred fifty-four trials evaluated the dose-related efficacy of atorvastatin in 33,505 participants. Log dose-response data revealed linear dose-related effects on blood total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides. Combining all the trials using the generic inverse variance fixed-effect model for doses of 10 to 80 mg/day resulted in decreases of 36% to 53% for LDL-cholesterol. There was no significant dose-related effects of atorvastatin on blood high-density lipoprotein (HDL)-cholesterol. WDAE were not statistically different between atorvastatin and placebo for these short-term trials (risk ratio 0.99; 95% confidence interval 0.68 to 1.45). AUTHORS' CONCLUSIONS Blood total cholesterol, LDL-cholesterol and triglyceride lowering effect of atorvastatin was dependent on dose. Log dose-response data was linear over the commonly prescribed dose range. Manufacturer-recommended atorvastatin doses of 10 to 80 mg/day resulted in 36% to 53% decreases of LDL-cholesterol. The review did not provide a good estimate of the incidence of harms associated with atorvastatin because of the short duration of the trials and the lack of reporting of adverse effects in 37% of the placebo-controlled trials.
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Affiliation(s)
- Stephen P Adams
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver,
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Loffredo L, Angelico F, Perri L, Violi F. Upstream therapy with statin and recurrence of atrial fibrillation after electrical cardioversion. Review of the literature and meta-analysis. BMC Cardiovasc Disord 2012; 12:107. [PMID: 23171447 PMCID: PMC3511171 DOI: 10.1186/1471-2261-12-107] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 11/15/2012] [Indexed: 01/07/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia observed in clinical practice. Electrical cardioversion (EC) is commonly used to restore and maintain sinus rhythm but it is characterized by high rate of recurrences. Several trials analyzed the effects of statins to reduce the recurrences in AF with contradictory results. Methods We performed a meta-analysis of the interventional trials with statins in patients with persistent AF to evaluate recurrences after EC. Only randomized controlled trials were included in the analysis. Data sources included: Medline, ISI Web of Science, SCOPUS and Cochrane database (up to June 2012). Data extraction was performed by three authors. Study-specific odds ratios (ORs) were combined using fixed-effects model. Results Six studies with 515 patients were included in the analysis. Statins used in the selected trials were: atorvastatin (at dosages ranging from 10 to 80 mg/day), pravastatin (40 mg/day) and rosuvastatin (20 mg/day). AF recurrence after EC occurred in 108/258 (41.8%) of patients treated with statins and in 132/257 (51.3%) patients not on treatment with statins. Compared with control, recurrences were significantly reduced with statin treatment (O.R.: 0.662; 95% C.I., 0.45-0.96; p=0.03); statin treatment was associated with an absolute risk reduction of 0.095 and a number needed to treat of 11. Conclusions This review suggests that statin therapy was significantly associated with a decreased risk of recurrence in patients with persistent AF after EC.
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Affiliation(s)
- Lorenzo Loffredo
- Clinica Medica, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
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Bang CN, Greve AM, Abdulla J, Køber L, Gislason GH, Wachtell K. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions: a systematic review and meta-analysis. Int J Cardiol 2012; 167:624-30. [PMID: 22999824 DOI: 10.1016/j.ijcard.2012.08.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 08/31/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous meta-analyses suggest that pre-procedural use of statin therapy may reduce atrial fibrillation (AF) following invasive cardiac interventions (coronary artery by-pass grafting and percutaneous coronary intervention). However, the current evidence on the benefit of statins unrelated to invasive cardiac interventions has not been clarified systematically. METHODS Through a systematic literature search, trials examining the effect of statin therapy on AF were selected. Trials using statins before any percutaneous or surgical cardiac interventions were excluded. RESULTS The search identified 11 randomized and 16 observational eligible studies, totaling 106,640 patients receiving statin therapy and 129,305 serving as controls. Fourteen studies investigated the effect of statins on new-onset AF, 13 studies investigated the effect of statins on recurrent AF and one in both new-onset and recurrent AF. In the statin versus control group the mean age was 60.7 ± 8.3 versus 68.6 ± 6.2 years and females comprised 8.4% versus 10.3%. Statin therapy was associated with significant reduction of AF (Risk ratio (RR): 0.81 [95% confidence interval (CI): 0.80-0.83], p<0.001) combining all studies. Assessing exclusively randomized trials, statin therapy showed no significant risk reduction (RR: 0.97 [95%CI: 0.90-1.05], p=0.509), heterogeneity p>0.05. Assessing exclusively observational studies the risk reduction of new-onset AF was 12% (RR: 0.88 [95%CI: 0.85-0.91], p<0.001) and recurrent AF 15% (RR: 0.85 [95%CI: 0.80-0.90], p<0.001), heterogeneity p<0.001. CONCLUSION The hitherto published randomized clinical trials do not support a beneficial effect of statins on AF in patients not undergoing invasive cardiac interventions. This is in contrast to the results of observational and interventional studies.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
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Fauchier L, Clementy N, Pierre B, Babuty D. Statin and Atrial Fibrilation: When does it work? J Atr Fibrillation 2012; 5:443. [PMID: 28496754 PMCID: PMC5153117 DOI: 10.4022/jafib.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 06/07/2023]
Abstract
In the recent years, some clinical and experimental studies have suggested that the use of statins may protect against atrial fibrillation (AF). A relation between inflammation and the development of AF has been described, and the potent anti-inflammatory and antioxidant properties of statins may make them effective in preventing the development of AF. A global analysis of the literature suggests that the use of statins is associated with a decreased risk of incidence or recurrence of AF in some cases. However, this beneficial effect is not seen for all types of AF in all the patients. The use of statins seems associated 1) with a lack of benefit in primary prevention of AF, 2) with a significant but heterogeneous decreased risk of recurrence of AF in secondary prevention, and 3) with a very significant and homogeneous reduction for the risk of post operative AF. An intensive lipid lowering statin regimen does not provide greater protection against AF. Patients with coronary heart disease are curr ently treated with statins in most cases, and this may not have an impact on their treatment. In contrast, it remains to determine more accurately if statins may bring a significant benefit for some AF patients without any type of established atherosclerotic disease or with a low risk of atherogenesis. Since it remains uncertain whether the suppression of AF in these patients is beyond doubt beneficial, prescribing statins for this purpose alone should not be recommended at the present time.
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Affiliation(s)
- Laurent Fauchier
- Service de Cardiologie B, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau, Tours, France Faculté de Médecine Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie B, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau, Tours, France Faculté de Médecine Université François Rabelais, Tours, France
| | - Bertrand Pierre
- Service de Cardiologie B, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau, Tours, France Faculté de Médecine Université François Rabelais, Tours, France
| | - Dominique Babuty
- Service de Cardiologie B, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau, Tours, France Faculté de Médecine Université François Rabelais, Tours, France
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40
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Höglund N, Andersson J, Almroth H, Tornvall P, Englund A, Rosenqvist M, Jensen SM, Boman K. The predictive value of C-reactive protein on recurrence of atrial fibrillation after cardioversion with or without treatment with atorvastatin. Int J Cardiol 2012; 167:2088-91. [PMID: 22704860 DOI: 10.1016/j.ijcard.2012.05.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 03/18/2012] [Accepted: 05/25/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether high-sensitivity C-reactive protein (hsCRP) levels prior to cardioversion (CV) predict recurrence of atrial fibrillation (AF) in patients randomized to treatment with either atorvastatin or placebo 30 and 180 days after CV. METHODS This was a prespecified substudy of 128 patients with persistent AF randomized to treatment with atorvastatin 80 mg/day or placebo, initiated 14 days before CV, and continued 30 days after CV. HsCRP levels were measured at randomization, at the time of CV, and 2 days and 30 days after CV. RESULTS In univariate analysis of those who were in sinus rhythm 2h after CV, hsCRP did not significantly (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.99-1.25) predict recurrence of AF at 30 days. However, after adjusting for treatment with atorvastatin, hsCRP predicted the recurrence of AF (OR 1.14, 95% CI 1.01-1.27). In a multivariate logistic regression analysis with gender, age, body mass index (BMI), smoking, cholesterol, and treatment with atorvastatin as covariates, the association was still significant (OR 1.14, 95% CI 1.01-1.29). Six months after CV, hsCRP at randomization predicted recurrence of AF in both univariate analysis (OR 1.30, 95% CI 1.06-1.60) and in multivariate logistic regression analysis (OR 1.33, 95% CI 1.06-1.67). CONCLUSION HsCRP was associated with AF recurrence one and six months after successful CV of persistent AF. However, the association at one month was significant only after adjusting for atorvastatin treatment.
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Affiliation(s)
- Niklas Höglund
- Heart Centre, Institution of Public Health and Clinical Medicine, Umeå University, S-901 85 Umeå, Sweden.
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41
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Bonilla IM, Sridhar A, Györke S, Cardounel AJ, Carnes CA. Nitric oxide synthases and atrial fibrillation. Front Physiol 2012; 3:105. [PMID: 22536189 PMCID: PMC3332924 DOI: 10.3389/fphys.2012.00105] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 04/02/2012] [Indexed: 11/13/2022] Open
Abstract
Oxidative stress has been implicated in the pathogenesis of atrial fibrillation. There are multiple systems in the myocardium which contribute to redox homeostasis, and loss of homeostasis can result in oxidative stress. Potential sources of oxidants include nitric oxide synthases (NOS), which normally produce nitric oxide in the heart. Two NOS isoforms (1 and 3) are normally expressed in the heart. During pathologies such as heart failure, there is induction of NOS 2 in multiple cell types in the myocardium. In certain conditions, the NOS enzymes may become uncoupled, shifting from production of nitric oxide to superoxide anion, a potent free radical and oxidant. Multiple lines of evidence suggest a role for NOS in the pathogenesis of atrial fibrillation. Therapeutic approaches to reduce atrial fibrillation by modulation of NOS activity may be beneficial, although further investigation of this strategy is needed.
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Affiliation(s)
- Ingrid M Bonilla
- College of Pharmacy, The Ohio State University Columbus, OH, USA
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42
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Ferro D, Franciosa P, Cangemi R, Carnevale R, Pignatelli P, Loffredo L, Perri L, Catasca E, Violi F. Serum Levels of Vitamin E Are Associated With Early Recurrence of Atrial Fibrillation After Electric Cardioversion. Circ Arrhythm Electrophysiol 2012; 5:327-33. [DOI: 10.1161/circep.111.968248] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background—
Oxidative stress is suggested to play a role in favoring the occurrence of atrial fibrillation (AF). We analyzed whether vitamin E, a known antioxidant, or markers of oxidative stress are associated with AF recurrence in patients undergoing electric cardioversion.
Methods and Results—
A total of 144 patients (83 men; mean age, 71.1±5.4 years) underwent successful biphasic electric cardioversion of nonvalvular persistent AF. At baseline, urinary 8-isoprostaglandin F2α and serum soluble NOX2-derived peptide (sNOX2-dp), high-sensitivity C-reactive protein (hs-CRP), and vitamin E levels were measured in each patient. All patients underwent 3 months of clinical follow-up, including an office visit with ECG every week or in cases of symptom recurrence. During the follow-up, 94 patients maintained sinus rhythm, whereas 50 experienced AF recurrence. In unadjusted analysis, left atrial diameter and levels of urinary isoprostanes and serum sNOX2-dp and hs-CRP were significantly higher and serum vitamin E lower in patients with AF recurrence. In multivariable Cox analysis, serum vitamin E (hazard ratio, 0.734; 95% CI, 0.605–0.891;
P
<0.001) and, to a lesser extent, hs-CRP (
P
=0.047) remained significantly associated with AF recurrence. Urinary isoprostanes and serum sNOX2-dp levels were inversely correlated with serum vitamin E level (
r
=−0.626,
P
<0.001, and
r
=−0.460,
P
<0.001, respectively).
Conclusions—
The study shows that low serum vitamin E levels are associated with AF recurrence in patients who underwent cardioversion. Because vitamin E inversely correlated with oxidative stress, the findings reinforce the hypothesis of an interplay between oxidative stress and AF.
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Affiliation(s)
- Domenico Ferro
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Pasquale Franciosa
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Roberto Cangemi
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Roberto Carnevale
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Lorenzo Loffredo
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Ludovica Perri
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Elisa Catasca
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
| | - Francesco Violi
- From the I Clinica Medica (D.F., R. Cangemi, R. Carnevale, P.P., L.L., L.P., E.C., F.V.) and Cardiac Department (P.F.), Sapienza University of Rome, Rome, Italy
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Smit MD, Maass AH, De Jong AM, Muller Kobold AC, Van Veldhuisen DJ, Van Gelder IC. Role of inflammation in early atrial fibrillation recurrence. Europace 2012; 14:810-7. [PMID: 22237586 DOI: 10.1093/europace/eur402] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS Outcome of rhythm control in atrial fibrillation (AF) is still poor due to various mechanisms involved in the initiation and perpetuation of AF. Differences in timing of AF recurrence may depend on different types of mechanisms. The aim of this study was to assess the mechanisms involved in early AF recurrence in patients with short-lasting AF. METHODS AND RESULTS Patients with short-lasting persistent AF undergoing rhythm control (n= 100) were included. Markers of mechanisms involved in the initiation and perpetuation of AF were assessed, including clinical factors, echocardiographic parameters, and biomarkers. Primary endpoint was early AF recurrence (recurrence <1 month). Secondary endpoint was progression to permanent AF. Median total AF history was short: 4.2 months. Early AF recurrences occurred in 30 patients (30%) after a median of 6 (inter-quartile range 2-14) days. Baseline log(2) interleukin (IL)-6 [adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI) 1.0-1.7, P= 0.02] and present or previous smoking (adjusted HR 3.6, 95% CI 1.2-10.9, P= 0.03) were independently associated with early AF recurrence, suggesting that inflammation played an important role in early recurrences. Atrial fibrillation became permanent in 29 patients (29%). Baseline transforming growth factor-β1, left ventricular ejection fraction, and early AF recurrence were independently associated with progression to permanent AF. CONCLUSION In patients with short-lasting AF, early AF recurrence seemed to be associated with inflammation as represented by IL-6. Treatment aimed against inflammation may therefore prevent early AF recurrences, which can improve rhythm control outcome.
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Affiliation(s)
- Marcelle D Smit
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Peña JM, MacFadyen J, Glynn RJ, Ridker PM. High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Eur Heart J 2011; 33:531-7. [PMID: 22187510 DOI: 10.1093/eurheartj/ehr460] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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 randomized 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 random allocation to rosuvastatin significantly reduced that risk.
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Affiliation(s)
- Jessica M Peña
- Center for Cardiovascular Disease Prevention, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA, USA.
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Reilly SN, Jayaram R, Nahar K, Antoniades C, Verheule S, Channon KM, Alp NJ, Schotten U, Casadei B. Atrial sources of reactive oxygen species vary with the duration and substrate of atrial fibrillation: implications for the antiarrhythmic effect of statins. Circulation 2011; 124:1107-17. [PMID: 21844076 DOI: 10.1161/circulationaha.111.029223] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An altered nitric oxide-redox balance has been implicated in the pathogenesis of atrial fibrillation (AF). Statins inhibit NOX2-NADPH oxidases and prevent postoperative AF but are less effective in AF secondary prevention; the mechanisms underlying these findings are poorly understood. METHODS AND RESULTS By using goat models of pacing-induced AF or of atrial structural remodeling secondary to atrioventricular block and right atrial samples from 130 patients undergoing cardiac surgery, we found that the mechanisms responsible for the NO-redox imbalance differ between atria and with the duration and substrate of AF. Rac1 and NADPH oxidase activity and the protein level of NOX2 and p22phox were significantly increased in the left atrium of goats after 2 weeks of AF and in patients who developed postoperative AF in the absence of differences in leukocytes infiltration. Conversely, in the presence of longstanding AF or atrioventricular block, uncoupled nitric oxide synthase activity (secondary to reduced BH4 content and/or increased arginase activity) and mitochondrial oxidases accounted for the biatrial increase in reactive oxygen species. Atorvastatin caused a mevalonate-reversible inhibition of Rac1 and NOX2-NADPH oxidase activity in right atrial samples from patients who developed postoperative AF, but it did not affect reactive oxygen species, nitric oxide synthase uncoupling, or BH4 in patients with permanent AF. CONCLUSIONS Upregulation of atrial NADPH oxidases is an early but transient event in the natural history of AF. Changes in the sources of reactive oxygen species with atrial remodeling may explain why statins are effective in the primary prevention of AF but not in its management.
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Affiliation(s)
- Svetlana N Reilly
- Department of Cardiovascular Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Gillis AM, Verma A, Talajic M, Nattel S, Dorian P. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Rate and Rhythm Management. Can J Cardiol 2011; 27:47-59. [DOI: 10.1016/j.cjca.2010.11.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022] Open
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