Women with Afib Helped by Statins

Lone Afibbers,

Here's a topic I just blogged about, based on findings just presented at the Heart Rhythm Society. This group will undoubtedly have comments to expand the conversation around this.
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Statins Help Women with Atrial Fibrillation

Post-menopausal women with existing heart disease have less risk of having or developing atrial fibrillation if they are taking statin drugs. This finding was reported at the Heart Rhythm Society’s annual meeting in San Francisco. It appears that it’s the anti-inflammatory properties of statins that cause this.

Find study at [www.healthcentral.com]

While the news stories say “older women benefit from taking statins” (the study focused just on post-menopausal women), it’s logical that it could apply to younger women as well (maybe men, too). Since inflammation causes heart disease and post-surgical atrial fibrillation, why shouldn’t something that reduces inflammation help reduce the risk of afib at any age?

I tell audiences that heart disease is forever--once you have it you’re at risk for more heart disease, stroke, and other issues. I believe that inflammation from all those chronic sinus infections (and a case of bronchitis) contributed to my heart disease at age 51 and may also have contributed to developing afib later that same year.

If you’re a woman with Lone Atrial Fibrillation, these results wouldn’t seem to apply to you. Or do they? I believe that some who have lone afib may also have undiagnosed heart disease. It’s heresy, I know, to say that, but please bear with me a moment while I explain why I believe that. [As she dons her flame-resistant suit.]

Since almost half of us will have (and die from) heart disease or stroke, is it logical to think that we just up and develop it one day? I don’t think so. Heart disease builds up over time, starting in our childhood.

So how could heart disease go undiagnosed in a woman? We’ve recently learned through the WISE (Women’s Ischemia Syndrome Evaluation) study [www.nhlbi.nih.gov] that women’s heart disease is different from men’s and that tests that diagnose heart disease in men often aren’t as accurate for women. For example, treadmill stress tests accurately pick up heart disease in men about 2/3 of the time, but it’s only about 1/3 of the time in women. The same applies to other tests that work well for men. Women may need different tests to find their heart disease, so just because a test came back clean doesn’t necessarily mean that you don’t have any heart disease.

So what can you do if you don’t want to take statin drugs? Lots of folks don’t. Would a naturally-occurring statin (such as red yeast rice) or a natural anti-inflammatory agent work? Logic says that they would, though I haven’t seen any randomized studies confirming it.

Bottom line for women: Finding ways to reduce inflammation could help control afib or reduce your risk of having it.

Does that work for men, too? Perhaps so.

Some resources for ideas on naturally-occurring statins and natural anti-inflammatories:

- Red Yeast Rice–Wikipedia [en.wikipedia.org]
- Overview of Natural Anti-inflammatory Agents–Medscape [www.medscape.com]
- Seven Ways to Protect Your Heart With Anti-Inflammatory Alternatives– Dr. Mercola [articles.mercola.com]

Hans, Do you have links that could help expand on this topic, especially from your sites? I'd love to add them to my blog, too, if that's OK.

I find my afib is less when I am using a low-dose progesterone cream. I have read (somewhere) that progesterone reduces inflammation. I'm not making a statement, just throwing in a contribution.

Kate

I’m weighing in as a statin skeptic. Look closely and note the write up says “post-menopausal women with existing coronary artery disease.” For them, a statin may be a viable option, but I’d really be cautious and they should also be prescribed the additional use of CoQ10 in relatively generous doses for protection.

Because hormone production (including sex hormones) relies on cholesterol, blocking the production cholesterol has functional side effects. Statins can cause memory loss and dementia, muscle pain and weakness and loss of libido and has a link with cancer. In men with endothelial dysfunction, the prevalence of ED (erectile dysfunction) is common. Of course this latter link is a hotly debated topic. Imagine the fallout - here are all these men on statins (cha ching $$) and then they have to take Viagra – double cha ching. Think of the revenue loss if they all stopped statins and then didn’t need Viagra-like drugs.

I’m post menopausal and would never consider taking a statin with or without afib. When I was 53, before menopause and before AF, my cholesterol was about 187 and my zealot doctor at the time thought it was too high. Being a compliant patient, I started the statin and not long afterwards, I began to develop muscle weakness in my legs. The doctor said, “nonsense”. I said, it’s the only drug I take and the only thing new in my regimen. He changed to another statin. Same thing. I stopped, but was left with muscle weakness later said to be mitochondrial dysfunction. That weakness has never resolved. Since then, I have never even been able to hop on one foot. Imagine that!

Most likely, the reason studies that suggest statins help prevent afib in post-menopausal women has to do with the reduction of inflammation. There are plenty of natural means that do not require the use of statin drugs or even the statin herbal, Red Yeast Rice…which does actually contain somenaturally occurring statin. (I also took that and had severe pain and weakness as well). Natural anti-inflammatories have been discussed frequently here regarding lowering C-reactive protein and studies show those with afib tend to have higher CRP which is a marker for inflammation.

Since statins deplete Coenzyme Q10 and interfere with that entire functional cascade including energy (ATP) production in the mitochondria, I think it’s a bad choice for any older person whose natural production of CoQ10 can be significantly depleted just as a result of the natural aging process. CoQ production begins to diminish in the 20’s.

The people who are anti-statins observe that Big Pharma’s goal is to get at least 60 million people on statins regularly. It’s observed that since most of the people with elevated cholesterol and related disease conditions are already on statins, they have to look to other populations to reach that target number. And, what would be more opportune than the increasing number of people who are being diagnosed with atrial fibrillation?

Refer to the section in my post last year - Caveat lector: Reliance on Published Studies is Risky
<[www.afibbers.org]>

This is about studies that aren’t backed up by facts and are written by ghost writers who to manipulate the data and information to give a positive spin to new drugs so doctors will prescribe more drugs. The post is based on the book by John Abramson, MD, author of Overdo$ed America.

Dr. Abramson says, referring to “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update”

These guidelines, obviously claiming to be evidence-based, cite 9 clinical trials in the back supporting the recommendations for "Hyperlipidemia." If you read the title of each of the 9 studies, however, you will see that 8 include only people who already have heart diseae, and the other includes only people with diabetes. So the "evidence based guidelines" for women, endorsed by the American Heart Association, published less than one month ago, shamelessly mislead doctors and their female patients once again into thinking that clinical trials have shown that statins have been shown in clinical trials to benefit women who don't yet have heart disease or diabetes when that is simply not true. I can't blame the doctor for trusting the sources he's been taught to trust. But the time has come for all of us to educate each other.
All the best,
Dr A


The downside of taking a statin is far reaching. CoEnzyme Q10 expert, Dr. William Judy says:

A recent release from Amer Jour Cardiology – big study about statins and lipids and cancer. 41,000 patients – shows an increased incidence in patients who take statins drugs and reach very low levels of LDLs. We know CoQ 10 is inhibited by statins; what we don’t know is that grandfather of CoQ in the body is the G protein which has been shown to stop the synthesis of farnesyl transferase that stimulates the rat’s oncogene and causes cancer cell growth.

There is news released today (last summer 7/25/07) that all drug companies have to do carcinogenic studies on their drugs. Eight out of 9 drug studies done in the late 80’s on statin drugs for carcinogenic activity showed that statins cause cancer in animals. The NIH studied it; made a recommendation, the FDA didn’t follow it and it is going to come back to bite us in the future with people taking high doses of statins – especially the elderly – having cancers.

Elderly people over 65 typically have marginal CoQ levels. The early Merck Sharpe & Dohm studies showed that only 1% of the study group on statins had any type of muscle weakness or involvement. His friend now retired from Merck says as much as 50% of the people over 65 taking statins and if their CoQ levels get down below .5, they have significant muscle side effects.

Cardiologist, Peter Langsjoen and his brother just recently looked at over 500 patients in their cardiology practice and found that almost 60% of those over 65 had muscle involvement, dementia, some brain involvement, cataracts that may be associated with high levels of statin drugs. Out of the 500, there were 40 that had developed heart failure from excess use of statins. The interesting thing is that the Langsjoen brothers took the ones with heart failure and gave them 300 mg of CoQ10 a day and reversed the statin effects upon the heart.

While statins may reduce the probability of heart attack and stroke, they have side effects that may outweigh the benefits especially in older people. The insert on statin drugs in Canada and England warns that the statin may interfere with energy and muscle function and if so these patients should take CoQ10. The International Co Q association tried to get that done with every FDA in the world –even the United States – but they were only successful in 2 or 3 places.

My comment:
Otherwise healthy people without coronary artery disease should be very cautious about buying into the need for statins. Do good research and make educated decisions.

Jackie

Hello Mellanie,

Thank you for bringing the Pelligrini study to our attention. Similar conclusions were reported in papers published in the American Journal of Cardiology in 2001. The Pelligrini study involved postmenopausal women diagnosed with coronary heart disease (CHD). I really can’t comment on the study until the details are published. For example, it is obviously crucial to know which criteria were used in the diagnosis of the CHD.

There is a considerable amount of evidence linking inflammation and atrial fibrillation, both lone and heart disease-related. In the case of heart disease-related afib (AF) there is evidence that the inflammation is related to the heart disease rather than to atrial fibrillation as such. On the other hand, in the case of lone atrial fibrillation (LAF) there is recent evidence that it is the LAF that is causing the afib and not the other way round.

I have assembled some of my recent abstracts on the subject here:

[www.afibbers.org]

As you will note the role of inflammation in LAF is by no means clear-cut. A recent Cleveland Clinic study found that CRP levels reverted to normal after a successful ablation and concluded that afib causes inflammation and not the other way round. As far as taking statin drugs for the prevention of LAF the evidence for benefit is again mixed. Some smaller studies have found a benefit while a large Norwegian study found no beneficial effect.

I would suggest that there are several natural anti-inflammatories that would be helpful in ameliorating systemic inflammation. They would likely be a better and safer option than statin drugs assuming one believes that inflammation is a cause of LAF and not the other way round. Of course, eliminating or at least controlling a systemic inflammation would in itself be a good measure irrespective of its effect, or lack thereof on LAF. In any case, I fully agree with Jackie that statin drugs, like all other drugs, can have very serious side effects and should be handled with care. Personally, I would never consider taking them.

Hans

Here's an interesting clip from an article in EPLab Digest noting inflammation response being contributory to afib.... (irritate the vagus by inflammation and you flirt with AF whether it comes from oxidative stress, continually elevated acidic pH, etc)

A cautionary note comes from Alessie and Schotten, who point out that multiple factors contribute to AF, such as acute atrial stretch, oxidative stress, atrial ischemia, inflammatory response, electrical remodeling, pathologic changes in atrial architecture and disturbances in atrial conduction.26 They remind us that all of these factors should be considered in treatment, not just the nerves.

26. Alessie M, Schotten U. Paroxysmal atrial fibrillation: Just a matter of nerves? Heart Rhythm 2006;3:209-211.

Jackie and Hans,

Thanks for your comments made while I was gone on the road.

Jackie said: "Otherwise healthy people without coronary artery disease should be very cautious about buying into the need for statins. Do good research and make educated decisions."

Jackie, I'm afraid I miscommunicated, probably due to my reposting it directly from the blog rather than summarizing or restating it for this much more educated and knowledgeable audience. I was NOT arguing in favor of statins (not hardly!), but was instead suggesting that perhaps natural anti-inflammatories could also reduce the risk of afib IN WOMEN, which is why I brought up alternatives to statins.

Hans said: "I have assembled some of my recent abstracts on the subject here: [www.afibbers.org]"

Hans, Great piece, with a lot of fascinating info. Is it OK for me to link to it from the blog because it has such a wealth of information?

I found several of the studies fascinating – first, Bordeaux, that being out of sinus rhythm causes inflammation rather than the other way around, and second, Mass General in Boston, that inflammation may not be as important in true lone afib as previously thought, and thus that studies on typical afib patients may not be applicable to lone afib patients. Of course, in both cases the study populations were largely male.

There were several main points I made that perhaps I should have better emphasized:

1) This was an afib study in WOMEN, FINALLY! While there has been a fair amount of research on afib and inflammation, it has been mostly on men. We now know that afib is slightly different in women and these studies were unique in that they were focused just on women. (FYI, one study just presented at HRS showed that women are way under-represented among those referred for catheter ablation. I know that to be the case for surgery as well.)

2) If statins' anti-inflammatory properties were beneficial for women by decreasing their risk of afib, then natural anti-inflammatories should also be beneficial for women. Yes, we know that anti-inflammatories are beneficial to men, but this confirmed that they could be beneficial to women as well.

3) While you may agree with the first two points, I suspect you may not agree with my third - that not all cases of lone afib are truly lone afib – but here's my logic for that...Some percentage of lone afibbers may have undetected/undiagnosed heart disease. Since 40-50% of us will have heart disease, stroke, or both, and we don't just start getting it when we get old – it builds up in our arteries for many years – it's likely that 40-50% of lone afibbers may actually have some heart disease. That's especially true for women. Heart disease in women is different – microvascular coronary artery disease, the form common in women, is generally undetected by most tests that work for men. So, when lone afibbers dismiss those things applicable to afibbers with heart disease, they may being doing themselves a disservice in the long run; later they may determine that they do have heart disease. I'm only trying to raise a potential red flag of something for LAF'ers to consider.

Thanks for your comments, and especially for the great work you both do in researching and sharing with all of us interested in afib.

Warmest regards,
Mellanie

Kate,

I wouldn't have thought of that as a natural anti-inflammatory for women. Very interesting comment. Thanks.

Mellanie

Hello Mellanie,

Yes, please feel free to put in a link to the inflammation information.

In regard to your point that women are "under-represented" when it comes to catheter ablation, please bear in mind that women are also vastly under-represented in the total lone afib population, which many studies, including my own surveys, have shown to consist of 80% males and 20% females.

Hans

Hans,

Thanks so much. I've posted your link and talked about it on the atrial fibrillation blog.

Do you think women are under-represented with lone afib because they have less of it, or because it's under-diagnosed in women? Women are often told by their doctors "It's just a panic attack, honey! Just go home and learn to live with it."

Mellanie

Mellanie,

The 20:80 or 25:75 ratio between men and women having lone atrial fibrillation is pretty well recognized worldwide. I think there could be a couple of reasons for this:

a) women tend to be far less fanatic about heavy exercise than are men. It is probably not an overestimate to suggest that at least half of men with vagal lone afib owe their condition to excessive endurance sports over a long period of time.

b) my surveys have consistently shown that women, particularly women with vagal afib, tend to be diagnosed significantly later in life than do men; this could be due to the same hormonal protection that gives women "a break" on early heart disease - pure speculation on my part :~)

c) of course, there could be some bias in diagnosis, but I would think it would be slight as lone afib is pretty easy to diagnose.

As far as ablation procedures are concerned, my latest survey of over 500 afibbers who had undergone ablations or maze procedures showed a 22:78 ration between women and men.

Hans

Hans,

Thanks.

I agree that the heavy exercise component is a big reason why fewer women seem to have afib. When I was growing up, girls didn't play sports. That's changed, so we'll probably see more women with vagal lone afib as a result.

The "hormones protect women from heart disease" myth is starting to be put to rest as we're learning more about why and how the mechanism of heart disease is different in women. Where men have plaque buildup that is like little mountains of plaque leading to blockage in discrete areas of their blood vessels, women have more microvascular coronary artery disease, in which the plaque plates out uniformly throughout the blood vessels, narrowing them like rusty pipes. Doctors and tests are looking for mountains of plaque, not rusty pipes, so women often aren't diagnosed with heart disease when they have it. It takes different tests to find it.

It just may be that women are more predisposed to regular afib than to lone afib. That would make sense since 61% of stroke deaths are in women and afib-induced strokes seem to be more of a risk in regular afib than in lone afib.

Mellanie