Clinical InvestigationValvular and Congenital Heart DiseaseEffect of lipid lowering on new-onset atrial fibrillation in patients with asymptomatic aortic stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study
Section snippets
Methods
All data origin from the SEAS study, a randomized, multicenter, double-blind, placebo-controlled study investigating whether intensive lipid lowering with simvastatin plus ezetimibe vs placebo in 1,873 patients (45 to 85 years of age) with asymptomatic AS (defined as echocardiographic aortic valve thickening accompanied by Doppler-measured aortic peak flow velocity between 2.5 and 4.0 m/s, normal left ventricular [LV] systolic function, and absence of symptoms according to independent local
Baseline characteristics
Among the 1,873 randomized patients, 310 baseline electrocardiograms were missing; thus, 1,563 electrocardiograms were available for analysis. Patients with baseline AF or previous AF were excluded (n = 142), leaving 1,421 with the necessary electrocardiographic and echocardiographic data to be included in the current report: 716 patients receiving simvastatin and ezetimibe and 705 placebo (Figure 1). The 310 patients with missing electrocardiogram did not differ in baseline characteristics
Discussion
This study is, to the best our knowledge, the first randomized clinical trial to show no effect of lipid lowering with simvastatin and ezetimibe on reducing new-onset AF in patients with mild-to-moderate asymptomatic AS. In addition, this study showed that new-onset AF was associated with a subsequent increase in nonhemorrhagic stroke and AS-related event rates during follow-up in initially asymptomatic AS. Finally, our study showed that incident of AF occurred more frequently in patients with
Conclusions
There was no effect of simvastatin 40 mg combined with ezetimibe 10 mg on the incidence of AF in patients with asymptomatic AS. Age and LV mass index predicted new-onset AF. Finally, new-onset AF was independently associated with adverse outcome related with a worsening of prognosis.
Disclosures
Drs Boman, Egstrup, Nienaber, Ray, Rossebø, Wachtell, and Gohlke-Baerwolf received honoraria from Merck & Co, Inc, the funding sponsor of the SEAS study.
Acknowledgements
We thank the SEAS study investigators.25
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2013, International Journal of CardiologyCitation Excerpt :Symptomatic patients are also at significant risk while awaiting surgery [1] and preoperative AF seems to increase late morbidity and maybe also mortality [4]. This is supported in a recently published study showing that new-onset AF in asymptomatic AS patients, was associated with a 2-fold increase of AS-associated outcomes and a 4-fold higher risk of non-hemorrhagic stroke [3]. Furthermore, mortality associated with AVR undertaken as non-elective surgery increases the risk of poor outcome.
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