Reduction in Ventricular Tachyarrhythmias With Statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II

Reduction in Ventricular Tachyarrhythmias With Statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II Anant K. Vyas, Hongsheng Guo, Arthur J. Moss, Brian Olshansky, Scott A. McNitt, W. Jackson Hall, Wojciech Zareba, Jonathan S. Steinberg, Avi Fischer, Jeremy Ruskin, Mark L. Andrews, for the MADIT-II Research Group This study retrospectively explores the association of statin use with appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia/ventricular fibrillation (VT/VF) in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. After adjusting for relevant covariates, statin use was associated with a 35% reduction in cardiac death or VT/VF, whichever occurred first, and a 28% reduction in ICD therapy for VT/VF. We evaluated whether statins have anti-arrhythmic effects by exploring the association of statin use with appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia/ventricular fibrillation (VT/VF) in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. A few studies have suggested that lipid-lowering drugs may have anti-arrhythmic effects in patients with coronary artery disease. Patients receiving an ICD (n = 654; U.S. centers only) in the MADIT-II study were categorized by the percentage of days each patient received statins during follow-up (90% to 100%, n = 386; 11% to 89%, n = 116; and 0% to 10%, n = 152). The Kaplan-Meier method with significance testing by the log-rank statistic and time-dependent proportional hazards regression analysis were used to evaluate the effect of statin use on the probability of ICD therapy for the combined end point VT/VF or cardiac death and for the end point VT/VF. The cumulative rate of ICD therapy for VT/VF or cardiac death, whichever occurred first, was significantly reduced in those with ≥90% statin usage compared to those with lower statin usage (p = 0.01). The time-dependent statin:no statin therapy hazard ratio was 0.65 (p < 0.01) for the end point of VT/VF or cardiac death and 0.72 (p = 0.046) for VT/VF after adjusting for relevant covariates. Statin use in patients with an ICD was associated with a reduction in the risk of cardiac death or VT/VF, whichever occurred first, and was associated with a reduction in VT/VF episodes. These findings suggest that statins have anti-arrhythmic properties.