Lipid lowering drugs and recurrences of life-threatening ventricular arrhythmias in high-risk patients

OBJECTIVES To evaluate a possible effect of lipid lowering drugs on recurrences of ventricular arrhythmias (VA) after implantable cardioverter defibrillator (ICD) implantation. BACKGROUND In patients with coronary artery disease (CAD), lipid lowering drugs reduce total and sudden cardiac death. Because the mechanism is not completely understood, we studied whether these drugs have a favorable influence on the occurrence of life-threatening VA in patients with CAD and ICD implants. METHODS We conducted an observational study in 78 patients with CAD and life-threatening VA, treated with an ICD. After ICD implantation, 27 patients were on treatment with lipid lowering drugs (group I) and 51 were not (group II). Patients were studied for the following end points: recurrences of VA requiring ICD intervention, cardiac death and hospitalization. RESULTS After a mean follow-up of 490 ± 319 days, 35 patients (45%) had recurrences of VA requiring ICD intervention. In multivariate analysis, the use of lipid lowering drugs (chi-square 6.33, p = 0.012) and poorly tolerated sustained monomorphic ventricular tachycardia as initial presentation (chi-square 4.84, p = 0.028) remained as independent predictors of recurrences of VA. Patients in groups I and II had similar baseline clinical characteristics, but patients in group I had a lower incidence of recurrences of VA (6/27 or 22% vs. 29/51 or 57%, p = 0.004) and of the combined end points of cardiac death and hospitalization (4/27 or 15% vs. 23/51 or 45%, p = 0.015) compared with patients in group II. CONCLUSIONS This is the first observation that the use of lipid lowering drugs is associated with a reduction of recurrences of VA in patients with CAD and ICD implants. These data require confirmation in a prospective randomized trial.