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Previous use of Statins and Atrial Electrical Remodeling in Patients with Cryptogenic Stroke
Maurizio Acampa1, Pietro Enea Lazzerini2, Francesca Guideri1
1Stroke Unit, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Siena, Italy.
Insights
Previous statin use was associated with lower P wave dispersion (PWD) in patients experiencing cryptogenic stroke. This suggests statins may help prevent atrial fibrillation (AF) by improving atrial conduction.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Atrial fibrillation (AF) is a primary cause of cardioembolic stroke and silent AF can lead to cryptogenic strokes.
- P wave dispersion (PWD) predicts AF and may indicate silent AF in cryptogenic stroke patients.
- Inflammation, reflected by C-reactive protein, impacts atrial conduction; statins possess anti-inflammatory properties.
Purpose of the Study:
- To investigate the impact of prior statin therapy on PWD in cryptogenic stroke patients.
- To explore statins' potential role in mitigating atrial conduction abnormalities linked to AF.
Main Methods:
- 131 cryptogenic stroke patients (mean age 69±13 years) were included.
- Comprehensive assessments included neuroimaging, arterial ultrasound, echocardiography, and ECG.
- P wave dispersion (PWD) was measured for all participants.
Main Results:
- Patients on statins (n=34) exhibited significantly lower PWD (41.7±12.2 ms) compared to the no-statin group (48.7±15.2 ms; p=0.01).
- Lower P index values were also observed in the statin group (14.2±3.7 ms vs 16.5±5.3 ms; p=0.02).
Conclusions:
- Lower PWD in cryptogenic stroke patients previously treated with statins was observed.
- Findings support statins' potential to modulate atrial electrophysiology and structure.
- Statins may reduce AF occurrence by preventing slowed and heterogeneous atrial conduction.
Background:
In the general population the leading cause of cardioembolic stroke is atrial fibrillation (AF). A silent AF is also the possible cause of many cryptogenic strokes. P wave dispersion (PWD), a predictor of AF, has been proposed as a marker of silent AF occurrence in these strokes. PWD correlates with high-sensitive C-reactive protein levels reflecting the role of inflammation in promoting a slowed and inhomogeneous atrial conduction. Statins have a multitude of additional effects beyond lipid lowering, in particular anti-inflammatory effects that may influence atrial conduction.
Objective:
The aim of this study was to evaluate the effects of previous statin use on PWD in patients with cryptogenic stroke, in order to highlight a possible role for statins in preventing atrial conduction alterations that predispose to AF.
Method:
We enrolled 131 patients (67 males, 64 females; mean age 69±13 years) with cryptogenic stroke. All patients underwent neuroimaging examination, arterial ultrasound examination, echocardiography and ECG. PWD was measured in all subjects.
Results:
Patients previously treated with statins (n: 34) had lower PWD and P index values in comparison with no-statin group (41.7±12.2 vs 48.7±15.2 ms, p=0.01, and 14.2±3.7 vs 16.5±5.3 ms, p=0.02, respectively).
Conclusions:
Our results show lower PWD values in cryptogenic stroke patients previously treated with statins. These findings provide support to the hypothesis that statins may play a role in modulating atrial electrophysiological and structural properties, preventing the occurrence of a slowed and heterogeneous atrial conduction and finally, reducing the occurrence of AF.
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