Statins under-treatment and mortality in patients with atrial fibrillation. Insights from the nationwide START registry

Abstract

Background and aimsStatins are mainstream drugs for cardiovascular (CV) prevention, but under-prescription is an important clinical challenge. Data on the use of single statins and on the rate of under-prescription in atrial fibrillation (AF) are lacking. We evaluated the association of statin underuse with mortality risk in a large AF cohort. Methods and resultsAs many as 5477 patients from the Italian nationwide START registry were included. The prevalence of different statins was reported and the association of under prescription with all-cause and CV mortality investigated.Mean age was 80.2 years, and 46.4% were women. Among 2899 patients with a clinical indication to statin, only 1578 (54.4%) were on treatment. In a mean follow-up of 22.5 ± 17.1 months, 491 (4.7%/year) deaths occurred (106 CV deaths, 1.0%/year). Atorvastatin and Simvastatin were inversely associated with all-cause (HR 0.692, 95% CI 0.519–0.923, p = 0.012 and HR 0.598, 95% CI 0.428–0.836, p = 0.003, respectively) and CV death (HR 0.372, 95% CI 0.178–0.776, p = 0.008 and HR 0.306, 95% CI 0.123–0.758, p = 0.010, respectively).The 1321 untreated patients were older, more frequently women and with a higher prevalence of diabetes, previous cerebrovascular disease, peripheral artery disease compared to those on treatment. Statin undertreatment was associated with higher risk of all-cause (HR 1.400, 95% CI 1.078–1.819, p = 0.012) and CV death (HR 2.057, 95% CI 1.188–3.561, p = 0.010). ConclusionsAF patients with an indication to statins but left untreated show a high risk of all-cause and CV mortality. Implementation of statin prescription in the AF population can help reducing the residual mortality risk.