Statins and the reduction of sudden cardiac death: antiarrhythmic or anti-ischemic effect?

Am J Cardiovasc Drugs. 2010;10(3):155-64. doi: 10.2165/11536690-000000000-00000.


Sudden cardiac death is an important cause of cardiovascular mortality with the majority of cases occurring in low-risk groups. HMG-CoA reductase inhibitors (statins) have recently been shown to reduce the incidence of ventricular tachycardia (VT)/fibrillation (VF) and sudden cardiac death, and this has been attributed to their pleiotropic effects. However, it is unclear whether this occurs through an 'indirect' anti-ischemic or 'direct' antiarrhythmic effect. We systematically reviewed articles published on MEDLINE between January 1996 and December 2009 focusing on the reduction of VT/VF and sudden cardiac death by statins and the potential mechanisms. Studies reporting sudden cardiac death or VT/VF outcomes with statin use (n = 23) or the pathophysiology of sudden cardiac death reduction by statins (n = 19) were included. We found that statins have been shown to reduce VT/VF and sudden cardiac death only in subjects with underlying coronary artery disease or ischemic cardiomyopathy. No definite benefits were seen with statins in sudden cardiac death and VT/VF in patients with non-ischemic cardiomyopathy. There is insufficient evidence to point toward a benefit in populations at low risk for VT/VF. In conclusion, an anti-ischemic rather than a primary antiarrhythmic effect emerges as the likely mechanism of sudden cardiac death reduction with statins.

Publication types

  • Review

MeSH terms

  • Anti-Arrhythmia Agents / pharmacology*
  • Anti-Inflammatory Agents / pharmacology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Myocardial Ischemia / prevention & control*
  • Randomized Controlled Trials as Topic
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / prevention & control
  • Ventricular Fibrillation / etiology
  • Ventricular Fibrillation / prevention & control


  • Anti-Arrhythmia Agents
  • Anti-Inflammatory Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors