So here I am putting the final touches on a series of presentations that I've been asked to give over the next several months. One of the topics is on atrial fibrillation & stroke prevention. Currently, we can decrease by two thirds the risk of stroke due to atrial fibrillation if we can convince our patients to take their anticoagulant as directed. But those two words "as directed" are the key between life and death.
I hate to be so melodramatic about adherence, but when it comes to taking traditional warfarin, you have to be very obsessive about taking your medication at the same time daily, eating the same amount of vitamin K rich foods (you don't have to avoid your leafy greens, just be sure to eat about the same serving size daily), and present yourself for monitoring on a regular basis.
The benefit of the new oral anticoagulants is the lack of impact nutrition has on their efficacy and the lack of need for laboratory monitoring. However, the ease of use of these new medications, eg Eliquis, Pradaxa & Xarelto, comes at a price (literally) as they're all available only by brand, and thus are much more expensive than warfarin which is available generically.
With that in mind, how about avoiding the development of atrial fibrillation in the first place? We can't do much about age as a risk factor but we can address the issue of high blood pressure or hypertension. And since there is a link between heart disease and atrial fibrillation, perhaps lowering cholesterol might help in some way. As it turns out, a
prospective observational study was published this month in the American Journal of Medicine in which the
authors concluded that statin use in elderly w/hypertension was associated w/lower risk of developing atrial fibrillation.
In the study, 27,002 patients (avg 73yo) w/hypertension were followed for 9 years. While
CHADS2 score is typically used to calculate risk of suffering a stroke, it was used in this study to determine who might benefit from statin treatment (or not). As it turned out, statin use was associated w/19% lower risk of developing atrial fibrillation. More importantly,
those with a CHADS2 score >2 reported a 31% lower risk w/statin use while no statin benefit was found in those w/CHADS2 score of 1.
So while there remains plenty of argument for the use of statins in coronary artery disease management and possibly even
cancer, its use should not be taken lightly in light of concern over possible development of
diabetes.
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