Atorvastatin Therapy for the Prevention of Atrial Fibrillation (SToP-AF)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00252967
Recruitment Status : Terminated (Insufficient power to show therapy difference at interim analysis.)
First Posted : November 15, 2005
Results First Posted : September 3, 2014
Last Update Posted : September 3, 2014
Information provided by (Responsible Party):
Samuel C. Dudley, Jr., Emory University

Brief Summary:
The purpose of this study is to test whether the drug, atorvastatin, will be able to reduce the rate of return of the abnormal beats after using cardioversion. Atorvastatin is a drug approved by the Food and Drug Administration (FDA) for the treatment of high cholesterol but is not approved for preventing abnormal heartbeats. In addition to lowering cholesterol, the drug reduces inflammation. Inflammation seems to help cause atrial fibrillation, a certain type of abnormal heartbeat. In animals, atorvastatin reduces the risk of this type of abnormal beats, and preliminary data in humans supports an effect of atorvastatin and other similar drugs that have the same action on reducing the risk of this type of abnormal beats. We, the researchers at Emory University, would like to learn if this drug could prevent the return of these abnormal heartbeats.

Condition or disease Intervention/treatment Phase
Atrial Fibrillation Inflammation Drug: Atorvastatin Drug: Placebo Phase 3

  Hide Detailed Description

Detailed Description:

Atrial fibrillation (AF) and its related disorder, atrial flutter (AFlut), are common abnormal heartbeats. Because they are similar and AFlut is rare compared to AF, they are usually treated similarly and discussed as one disorder. AF is an extremely common arrhythmia affecting more that 5% of the population over 65 years of age. It is an independent risk factor for death. AF is considered a progressive disease increasing in prevalence with age and converting from paroxysmal to permanent within a single individual. The projected lifetime risk of AF is 1 in 4 for men. AF occurs when there is an electrical short circuit in the top parts of the heart (atria). This causes the atria to beat at >300 times per min in an irregular and ineffective manor. This has two consequences. The blood tends to pool in the atria allowing for clotting. Second, the bottom parts of the heart (ventricles) beat too rapidly in response to impulses arising in the atria. The rapid ventricular contraction without adequate filling time results in a reduced ejection of blood. This can cause heart failure symptoms such as shortness of breath and reduced blood flow to organs resulting in lightheadedness or collapse.

One logical therapy to correct the defects arising from AF is return the abnormal heartbeats back to the normal rhythm. This can be done with electrical shock therapy (cardioversion) or by drugs called antiarrhythmic agents. Often, they are used together. While its stands to reason that using these techniques to restore rhythm to normal would be beneficial, clinical trials show that leaving patients in AF and thinning the blood to prevent blood clots is equally efficacious to trying to restore normal beating (sinus rhythm). The common explanations for this are that AF returns rapidly despite antiarrhythmic drugs and that antiarrhythmic drugs can make worse abnormal heart beats, a phenomenon known as proarrhythmia.

Based on the lack of efficacy of current therapies and similarities between risk factors for atherosclerosis (hardening of the arteries) and AF, we began to investigate whether oxidative stress, a mechanism similar to inflammation thought to be responsible for atherosclerosis, might be playing a role in causing AF. We studied this in pigs first and found that when we put pigs into AF, they had a large increase in oxidative stress markers. Then, we made a mouse that had too much oxidative stress in the heart, and this mouse developed AF. Based on this and other data in humans, we hypothesized that oxidative stress can cause AF.

Atorvastatin is a cholesterol lowering medication that works by blocking production of cholesterol at an early stage. This has the effect of preventing the synthesis of molecules required to assemble the most common enzymatic source of oxidative stress, the NADPH oxidase. Therefore, atorvastatin decreases oxidative stress in addition to reducing cholesterol, and if our hypothesis is correct, atorvastatin should reduce the incidence of AF.

In this study we chose to look at patients undergoing cardioversion. This is because this group has a high likelihood of recurrence of AF and would benefit most by an effective drug. Once the decision is made to have the patient undergo cardioversion, we will approach the patient about enrolling in this trial. The only change in their medical therapy will be the addition of the study drug. The study requires no other alterations to the standard of care. If patients agree to participate, then they will be started on the study drug and followed for recurrence of AF by a variety of surface electrocardiogram techniques. All of which are noninvasive. To insure the medicine is not causing side effects, examinations and blood tests will be done, and to study whether the drug actually affects oxidative stress, blood will be analyzed. The subjects participation ends when AF recurs or after 1 year. This will be a double blind, placebo controlled trial and will be analyzed on an intention to treat basis.

The risks of this study to the patient are likely to be small compared to the potential benefit of reduced AF burden. Based on a previous trial using the same dose of study medication, the risks of all study drug related adverse events is likely to be <3%. All of these are expected to be reversible with discontinuation of the drug.

The significance of this research is that currently treatments to address AF are less than optimal. Antiarrhythmic drugs are variably effective and are associated with potentially lethal proarrhythmic side effects. The common treatment to prevent strokes in subjects with AF is chronic warfarin administration, but warfarin therapy requires frequent monitoring and adjustment of dose and is associated with bleeding complications. This research may provide the first new therapeutic strategy in many years for AF and the most serious consequence of AF, stroke.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 64 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Prevention
Official Title: Atorvastatin Therapy for the Prevention of Atrial Fibrillation (SToP-AF)
Study Start Date : October 2005
Actual Primary Completion Date : November 2008
Actual Study Completion Date : October 2009

Arm Intervention/treatment
Placebo Comparator: Placebo
Placebo taken daily
Drug: Placebo
Experimental: Atorvastatin
Atorvastatin at a dose of 80 mg daily
Drug: Atorvastatin
80 mg of Atorvastatin

Primary Outcome Measures :
  1. Time of Atrial Fibrillation Recurrence [ Time Frame: Upon recurrence, up to 12 months ]

Secondary Outcome Measures :
  1. Comparison of Redox Potential for Cysteine Values [ Time Frame: Baseline and 30 days ]
  2. Comparison of Redox Potential for Glutathione Values [ Time Frame: Baseline and 30 days ]
  3. Comparison of Derivatives of Reactive Oxygen Metabolites Values [ Time Frame: Baseline and 30 days ]
  4. Comparison of Isoprostanes Values [ Time Frame: Baseline and 30 days ]
  5. Comparison of Interleukin-6 Values [ Time Frame: Baseline and 30 days ]
  6. Comparison of Interleukin-1 Values [ Time Frame: Baseline and 30 days ]
  7. Comparison of High Sensitivity C-reactive Protein [ Time Frame: Baseline and 30 days ]
  8. Comparison of Tumor Necrosis Factor Alpha Values [ Time Frame: Baseline and 30 days ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • > or = 18 years of age
  • Clinical diagnosis-abnormal heart beat known as atrial fibrillation/flutter (ECG documentation)
  • Able to swallow pill form of drug

Exclusion Criteria:

  • < 18 years of age
  • enrollment in another ongoing trial
  • paroxysmal atrial fibrillation
  • hemodynamic instability
  • atrial fibrillation ablation within 6 months of enrollment
  • a contraindication for anticoagulation
  • severe valvular heart disease
  • presence of single lead implantable cardioverter defibrillator
  • unstable angina
  • New York Heart Association (NYHA) Class IV heart failure
  • hyperthyroidism
  • uncontrolled hypertension (blood pressure > 180/100 at rest) on medications
  • an illness that would limit life expectancy to less than 1 year
  • use of statins within the previous 30 days
  • significant coronary artery disease or lipid abnormalities necessitating statin therapy
  • implanted devices for active management of arrhythmias by pacing or defibrillation
  • lack of access to a telephone
  • illicit drug use
  • alcohol abuse
  • hypersensitivity to atorvastatin by history
  • pregnancy
  • sexually active female subjects not on contraception or surgically sterilized
  • nursing mothers
  • chronic liver disease or abnormal liver function (elevated transaminases 1.5 times the upper limit of normal [ULN] of laboratory reference range)
  • severe renal disease (creatinine > 200 mmol/L)
  • inflammatory muscle disease or creatine kinase (CK) > 3 times ULN
  • concurrent treatment with cyclosporine, fibrates, or high-dose niacin

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00252967

United States, Georgia
Veteran Administration Medical Center/Emory University
Atlanta, Georgia, United States, 30033
Crawford Long Hospital
Atlanta, Georgia, United States, 30322
The Emory Clinic
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Principal Investigator: Samuel D. Dudley, Jr., MD, PhD Veterans Administration Medical Center

Publications of Results:
Negi, S., Shukrullah, I., Veladar, E., Bloom, H., Jones, D., S.C. Dudley, Jr. (2010). Statin Therapy for Prevention of Atrial Fibrillation Trial (SToP AF trial). [Abstract]. ACC 2010. 10-A-11608-ACC.

Responsible Party: Samuel C. Dudley, Jr., MD, Emory University Identifier: NCT00252967     History of Changes
Other Study ID Numbers: IRB00024771
1137-2004 ( Other Identifier: Other )
First Posted: November 15, 2005    Key Record Dates
Results First Posted: September 3, 2014
Last Update Posted: September 3, 2014
Last Verified: August 2014

Keywords provided by Samuel C. Dudley, Jr., Emory University:
Reactive Oxgen Speers
Atrial Fibrillation
Oxidative Stress

Additional relevant MeSH terms:
Atrial Fibrillation
Pathologic Processes
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Atorvastatin Calcium
Anticholesteremic Agents
Hypolipidemic Agents
Molecular Mechanisms of Pharmacological Action
Lipid Regulating Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Enzyme Inhibitors