Key result
Higher levels of total cholesterol were consistently associated with a lower risk of incident atrial fibrillation in both statin users (HR 0.81) and non-users (HR 0.81).
Why the study?
Statin use might confound the paradoxical association between higher lipid levels and lower AF risk, but this relationship has not been thoroughly evaluated distinguishing statin users from non-users.
Does statin usage alter the paradoxical inverse association between lipid levels (TC and LDL-C) and incident atrial fibrillation in adults?
Cohort (n=9,778,014)
Does statin usage alter the paradoxical inverse association between lipid levels (TC and LDL-C) and incident atrial fibrillation in adults?
Hazard Ratio: 0.81 (95% CI 0.8–0.83)
p-value: p=<0.001
The paradoxical inverse relationship between lipid levels (TC and LDL-C) and the risk of incident atrial fibrillation remains consistent regardless of statin usage.
Objective: Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a lower risk of atrial fibrillation (AF).Statin use might exert confounding effects on the paradoxical associations; however, the relationships that distinguish statin users from non-users have not been thoroughly evaluated.Methods: From the Korean National Health Insurance Database, we included 9,778,014 adults who underwent a health examination in 2009.The levels of TC and LDL-C at the health examination were categorized into quartile values of the total study population.We grouped the study population into statin users and non-users and investigated the associations between TC, LDL-C, and the risk of incident AF.Results: Of the total population, 867,336 (8.9%) were taking statins.During a mean followup of 8.2 years, inverse associations of TC -AF and LDL-C -AF were observed; higher levels of TC and LDL-C were associated with the lower risk of AF in the total population.Overall, statin users showed higher AF incidence rate than non-users, but the inverse associations of TC -AF and LDL-C -AF were consistently observed irrespective of statin usage; adjusted hazard ratio with 95% confidence interval was 0.81 (0.79-0.84) for statin users and 0.81 (0.80-0.83) for non-users in the highest TC quartile, and 0.84 (0.82-0.87) for statin users and 0.85 (0.84-0.86) for non-users in the highest LDL-C quartile (all p<0.001). Conclusion:The paradoxical relationship between lipid levels (TC and LDL-C) and the risk of AF remains consistent in both statin users and non-users.
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Ahn et al. (2022) conducted a cohort in Incident Atrial Fibrillation (n=9,778,014). High levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) vs. Lowest quartile of TC and LDL-C was evaluated on Incident Atrial Fibrillation (HR 0.81, 95% CI 0.80-0.83, p=<0.001). Higher levels of total cholesterol were consistently associated with a lower risk of incident atrial fibrillation in both statin users (HR 0.81) and non-users (HR 0.81).
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