Lipid-lowering therapy reduced all-cause death risk by 18-33% and the composite endpoint by 16% in atrial fibrillation patients over 2 years.
Does lipid-lowering therapy reduce all-cause death and cardiovascular events in edoxaban-treated patients with atrial fibrillation?
Baseline use of lipid-lowering therapy in edoxaban-treated patients with atrial fibrillation is associated with a significantly lower risk of all-cause death, regardless of underlying atherosclerotic risk.
Abstract Background There is limited evidence on the association between the use of lipid-lowering therapy (LLT) and cardiovascular (CV) disease in patients with atrial fibrillation (AF). The interaction between LLT, AF-related stroke risk and atherosclerosis-related CV disease remains unexplored. Purpose To assess the relationship between LLT use and CV disease in edoxaban-treated AF patients in routine clinical practice in Europe and Asia. Methods The Global ETNA-AF program is a prospective, noninterventional, observational study comprising 3 regional patient registries in Europe, Japan and other Asian countries. This analysis excluded Japanese patients as LLT use was not recorded. Here we report annualised event rates (%/y) of all-cause death and composite endpoint (any stroke/transient ischaemic attack/systemic embolic event/all-cause death/myocardial infarction) with/without LLT use at baseline and categorised by thromboembolic risk (measured by CHA2DS2-VASc score) and atherosclerotic risk (indicated by prior CV event/disease). Prior CV event/disease was defined as acute coronary syndrome, percutaneous coronary intervention, or peripheral artery disease. The association between LLT use and CV events was assessed using adjusted Cox regression. Results Of 16,463 patients in the full analysis set, 16,080 had a calculable CHA2DS2-VASc score and were categorised by thromboembolic risk. At baseline, 16.3% of patients had prior CV event/disease (Table). Overall, 61.4% of patients with prior CV event/disease received LLT at baseline compared with 28.7% of those without. Regardless of atherosclerotic risk, the proportion of patients with AF who received LLT at baseline increased with higher thromboembolic risk. Risk of all-cause death was significantly higher in patients without vs with LLT at baseline, both among those with prior CV event/disease (overall annualised event rates were 6.21%/y vs 4.67%/y; HR 1.33, 95% CI 1.04–1.70) and without prior CV event/disease (3.34%/y vs 2.82%/y; HR 1.18, 95% CI 1.01–1.38; Figure 1A). Across all thromboembolic risk categories, regardless of atherosclerotic risk, patients who received LLT had numerically lower annualised all-cause death rates vs those who did not. In patients without prior CV event/disease risk of the composite endpoint was significantly higher in those without vs with LLT (4.43%/y vs 3.81%/y; HR 1.16, 95% CI 1.01–1.33; Figure 1B). However, in patients with prior CV event/disease, risk of the composite endpoint was numerically but not significantly higher in those without vs with LLT (7.72%/y vs 6.59%/y; HR 1.17, 95% CI 0.95–1.45; Figure 1B). Conclusions LLT use at baseline was associated with a significantly lower risk of all-cause death regardless of atherosclerotic risk. Risk of composite endpoint was significantly lower in LLT users without prior CV event/disease; likewise a trend towards a lower risk, although not statistically significant, was noted in LLT users with prior CV event/disease.
Groot et al. (2025) studied this question. Lipid-lowering therapy reduced all-cause death risk by 18-33% and the composite endpoint by 16% in atrial fibrillation patients over 2 years.