Evaluation of the Paradoxical Association Between Lipid Levels and Incident Atrial Fibrillation According to Statin Usage: A Nationwide Cohort Study

• Published in: Journal of lipid and atherosclerosis Vol. 12; no. 1; pp. 73 - 86
• Main Authors: Ahn, Hyo-Jeong, Lee, So-Ryoung, Choi, Eue-Keun, Lee, Seung-Woo, Han, Kyung-Do, Kwon, Soonil, Oh, Seil, Lip, Gregory Y. H.
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Lipidology and Atherosclerosis 01.01.2023; 한국지질동맥경화학회
• Subjects: Original; 내과학; Association; Atrial fibrillation; Cholesterol; Lipid
• ISSN: 2287-2892; 2288-2561
• DOI: 10.12997/jla.2023.12.1.73

Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a lower risk of atrial fibrillation (AF). Statin use might exert confounding effects on the paradoxical associations; however, the relationships that distinguish statin users from non-users have not been thoroughly evaluated. From the Korean National Health Insurance Database, we included 9,778,014 adults who underwent a health examination in 2009. The levels of TC and LDL-C at the health examination were categorized into quartile values of the total study population. We grouped the study population into statin users and non-users and investigated the associations between TC, LDL-C, and the risk of incident AF. Of the total population, 867,336 (8.9%) were taking statins. During a mean follow-up of 8.2 years, inverse associations of TC - AF and LDL-C - AF were observed; higher levels of TC and LDL-C were associated with the lower risk of AF in the total population. Overall, statin users showed higher AF incidence rate than non-users, but the inverse associations of TC - AF and LDL-C - AF were consistently observed irrespective of statin usage; adjusted hazard ratio with 95% confidence interval was 0.81 (0.79-0.84) for statin users and 0.81 (0.80-0.83) for non-users in the highest TC quartile, and 0.84 (0.82-0.87) for statin users and 0.85 (0.84-0.86) for non-users in the highest LDL-C quartile (all <0.001). The paradoxical relationship between lipid levels (TC and LDL-C) and the risk of AF remains consistent in both statin users and non-users.