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 recurre nces of ventricular arrhythmias (VA) after implantable cardioverter defibri llator (ICD) implantation. BACKGROUND In patients with coronary artery disease (CAD), lipid lowering d rugs reduce total and sudden cardiac death. Because the mechanism is not co mpletely understood, we studied whether these drugs have a favorable influe nce on the occurrence of life-threatening VA in patients with CAD and ICD i mplants. METHODS We conducted an observational study in 78 patients with CAD and lif e-threatening VA, treated with an ICD. After ICD implantation, 27 patients were on treatment with lipid lowering drugs (group I) and 51 were not (grou p II). Patients were studied for the following end points: recurrences of V A requiring ICD intervention, cardiac death and hospitalization. RESULTS After a mean follow-up of 490 +/- 319 days, 35 patients (45%) had r ecurrences of VA requiring ICD intervention. In multivariate analysis, the use of lipid lowering drugs (chi-square 6.33, p = 0.012) and poorly tolerat ed sustained monomorphic ventricular tachycardia as initial presentation (c hi-square 4.84, p = 0.028) remained as independent predictors of recurrence s of VA. Patients in groups I and II had similar baseline clinical characte ristics, 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 o f cardiac death and hospitalization (4/27 or 15% vs. 23/51 or 45%, p = 0.01 5) compared with patients in group II. CONCLUSIONS This is the first observation that the use of lipid lowering dr ugs is associated with a reduction of recurrences of VA in patients with CA D and ICD implants. These data require confirmation in a prospective random ized trial. (C) 2000 by the American College of Cardiology.