Effects of lipid-altering therapies on ventricular arrhythmias and sudden cardiac death

Sudden cardiac death remains a leading cause of mortality in the United States, with an incidence of 300,000 to 400,000 deaths annually. Despite advances in the management of cardiovascular disease, the only effective treatments proven to reduce the risk of sudden cardiac death are beta-adrenergic blockers and implantable cardioverter-defibrillators. Antiarrhythmic medications are effective at treating symptomatic and asymptomatic ventricular arrhythmias, but several are associated with increased mortality. Although effective at lowering mortality, implantable cardioverter-defibrillators pose an economic burden and some morbidity to patients when associated with frequent shock therapies. Thus, there is renewed interest in developing additional pharmacologic alternatives that could reduce the risk of fatal ventricular arrhythmias. A post hoc analysis of 2 large clinical trials suggested an association between the use of lipid-altering therapy and decreased rates of sudden death. Retrospective review of other clinical trials and experimental data using animal models provide further insight into the potential antiarrhythmic properties of lipid-altering therapy. This review examines the current status of basic science and clinical research that explores the antiarrhythmic properties of lipid-altering therapy, with a focus on 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and polyunsaturated fatty acids.