Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
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 the risk of stroke due to atrial fibrillation by two thirds 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 presenting 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. 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 with hypertension was associated w/lower risk of developing atrial fibrillation.
In the study, 27,002 patients (avg 73yo) with hypertension were followed for 9 years. While CHADS2score 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 with statin use while no statin benefit was found in those with a 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.
