Author’s Reply

To the Editor,

We thank the authors for their comments on our article entitled “Efficiency of postoperative statin treatment for preventing new onset postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting: a prospective randomized study” published in Anatol J Cardiol 2015; 15: 491-5 (1). Our prospective and randomized study with a statin therapy regimen in the early postoperative period showed a statistically significant decrease in postoperative new-onset AF and a significant decrease in CRP levels in patients undergoing isolated CABG (1).

Preoperative statin therapy is also shown to reduce the incidence of postoperative AF (2, 3). ARMYDA-3 was the first randomized, controlled trial to evaluate the impact of preoperative statin therapy on postoperative AF. In that study, the peak CRP levels were not different between the placebo and atorvastatin groups, but preoperative atorvastatin reduced the risk of postoperative AF (2).

Recent studies have shown that statins reduce the CRP level in 2 weeks (4). Sakamoto et al. (3) started statin therapy in the preoperative period and showed that statins reduce the CRP level in the 7^th postoperative day. The largest study is a systematic review of 91491 patients who showed a reduction in postoperative AF with preoperative statin therapy. In conclusion, preoperative statin therapy in patients undergoing elective cardiac surgery is associated with reduced levels of inflammatory markers postoperatively (5).

Sakamoto et al. (3) detected a delay of approximately 2 days in the occurrence of AF in patients with preoperative statin therapy compared with those without statin therapy. This fact is meaningful for postoperative care as it indicates that preoperative statin therapy can avoid AF development in unstable hemodynamics immediately after surgery.

Recently, CABG is frequently performed on the day after coronary angiography; therefore, preoperative statin therapy cannot be administered in most patients. The patients did not have preoperative statin therapy in our study, and we did not detect any difference in the occurrence day of the first postoperative AF. Therefore, we suggest that statin therapy should be preoperatively started if available (1).

Moreover, other mechanisms might contribute to the clinical benefit of statins such as antioxidant effects, direct antiarrhythmic effects by cell membrane ion channel stabilization, improvement of coronary flow velocity reserve by vasodilation of coronary microvessels, rapid (<12 h after a single dose of atorvastatin) improvement of endothelial function, or direct protection of the myocardium and might also play a role in extracellular matrix modulation (3, 4). These effects might contribute to the prevention of atrial fibrillation of statins.

In light of our study results, we suggest that if preoperative statin therapy is not administered to patients, statin therapy should be started in a short time postoperatively to obtain the beneficial effects of statins.