The findings of this meta-analysis suggest that statins have a modest beneficial effect on sudden cardiac death. However, previous suggestions of a substantial protective effect on ventricular arrhythmic events were not supported by the analysis. The researchers carried out a meta-analysis of all large-scale trials of a statin vs. a control, or of a more vs. a less intensive statin regimen, which collected, but not necessarily published, data on ventricular arrhythmic events. They sought to estimate the effects separately on ventricular tachyarrhythmia, cardiac arrest, and sudden cardiac death.

A search of the literature up until October 2010 considered randomised controlled trials comparing statin with no statin or comparing intensive vs. standard dose statin, with more than 100 participants and at least 6-month follow-up for inclusion and relevant unpublished data obtained from the investigators. In total 29 trials of statin vs. control (113,568 participants) were included in the main analyses. The results for these trials showed:

• Statin therapy did not significantly reduce the risk of ventricular tachyarrhythmia [212 vs. 209; odds ratio (OR) = 1.02, 95% confidence interval (CI) 0.84–1.25, P = 0.87] or of cardiac arrest (82 vs. 78; OR = 1.05, 95% CI 0.76–1.45, P = 0.84), but was associated with a significant 10% reduction in sudden cardiac death (1131 vs. 1252; OR = 0.90; 95% CI 0.82–0.97, P = 0.01).

• This compared with a 22% reduction in the risk of other ‘non-sudden’ (mostly atherosclerotic) cardiac deaths (1235 vs. 1553; OR = 0.78, 95% CI 0.71–0.87, P < 0.001).

• Results were not materially altered by inclusion of eight trials (involving 41,452 participants) of intensive vs. standard dose statin regimens.

The researchers discuss limitations to their study and conclude, “Reducing LDL cholesterol with a statin reduces the risk of sudden cardiac death but the proportional benefit is small compared with that seen for other fatal cardiac events and may be explained by ‘upstream’ anti-atherosclerotic lipid-lowering effects. By contrast, there is no direct evidence that statins significantly reduce the risk of ventricular tachyarrhythmia.”