Background: The effectiveness of statin use in preventing adverse cardiovascular events in individuals with atrial fibrillation (AF) has remained uncertain. This study aimed to assess whether statin use could lead to better outcomes among individuals with AF. Methods and Results: We enrolled 397 787 patients with AF from January 1, 2012 to December 31, 2020. Patients with AF were divided into 2 groups (statin user and statin nonuser), and the risks of composite outcomes (including ischemic stroke, hemorrhagic stroke, and transient ischemic attack), all‐cause death, and major adverse cardiovascular events (which encompassed cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization) were analyzed. We analyzed 288 958 patients with newly diagnosed AF (mean age, 73 years; 44% women; mean CHA ₂ DS ₂ ‐VASc score, 3.5). Compared with patients without statin use, statin users had lower risks of composite end points (adjusted hazard ratio [HR], 0.91 [95% CI, 0.87–0.94]; P <0.01). In regard to all‐cause death, statin users exhibited a 67% risk reduction compared with statin nonusers (adjusted HR, 0.33 [95% CI, 0.32–0.33]; P <0.01). Statin use was also associated with reduced incidence of major adverse cardiovascular events (adjusted HR, 0.64 [95% CI, 0.63–0.66]; P <0.01). In the subgroups stratified by CHA ₂ DS ₂ ‐VASc score, statin therapy was particularly effective for patients with CHA ₂ DS ₂ ‐VASc scores 0 to 3 for composite end points but consistently reduced all‐cause mortality and major adverse cardiovascular events across all score categories. Conclusions: Among patients with newly diagnosed AF, statin use was associated with lower risk of ischemic stroke, hemorrhagic stroke, transient ischemic attack, all‐cause mortality, and major adverse cardiovascular events.

Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups.

Background: Despite a preferred endocrine therapy for women with estrogen and progesterone receptor-positive breast cancer, aromatase inhibitors (AIs) have been reported to increase risks of cardiovascular events. Given that breast cancer patients in Asia are younger at diagnosis, it is urgent to investigate this safety concern. Methods: Through the Taiwanese National Cohort, we identified breast cancer patients initiating selective estrogen receptor modulators (SERMs) or AIs from 2010 to 2016. Outcomes includes major adverse cardio- and cerebrovascular events (MACCEs). The average follow-up duration was five years. Results: We identified 16,730 breast cancer patients treated with SERMs and 11,728 receiving AIs. The population was older and had more comorbidities in the AI group than in the SERM group. After adjusting for age, cancer stage, cancer therapies, cardiovascular drugs and comorbidities, despite similar risks of MACCEs between AI and SERM users, the risk of HF was significantly higher in patients treated with SERMs after adjusted mortality as a competing risk. When divided by the age of 50 years, despite a similar MACCEs in the younger population, MACCEs remained significantly higher in the older population who received SERMs. Conclusions: In this Asian cohort, we found that among patients of old age or with advanced cancer stage, the use of SERMs was associated with a higher risk of cardiovascular events than the use of AIs.

Background: Sodium‐glucose cotransporter‐2 (SGLT2) inhibitors reduce incident atrial fibrillation (AF), but their association with cerebrovascular and cardiovascular outcomes after AF diagnosis remains uncertain. We evaluated these outcomes in patients with newly diagnosed AF. Methods: Using Taiwan's National Health Insurance Research Database, we identified patients with newly diagnosed AF from 2013 through 2022. Regular SGLT2 inhibitor users were propensity score matched 1:10 to nonusers. The primary outcome was a composite of ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Secondary outcomes were all‐cause mortality and major adverse cardiovascular events. Results: Of 231 030 eligible patients, 20 911 were included in the matched analysis: 1901 users and 19 010 nonusers (mean age, 72 years; 41% women; mean CHA ₂ DS ₂ ‐VASc score, 3.7). Baseline SGLT2 inhibitor use was not significantly associated with the primary outcome (adjusted hazard ratio [HR], 0.90 [95% CI, 0.70–1.15]; P =0.39), all‐cause mortality (adjusted HR, 0.95 [95% CI, 0.86–1.06]; P =0.38), or major adverse cardiovascular events (adjusted HR, 0.94 [95% CI, 0.84–1.05]; P =0.24). In a time‐dependent sensitivity analysis, current SGLT2 inhibitor exposure was associated with lower all‐cause mortality (adjusted HR, 0.71 [95% CI, 0.63–0.81]; P <0.01). Conclusions: Among patients with newly diagnosed AF, baseline SGLT2 inhibitor use was not significantly associated with lower risks of cerebrovascular events or major adverse cardiovascular events. The lower mortality observed in the time‐dependent analysis should be interpreted cautiously because of potential residual confounding. SGLT2 inhibitors should not be considered an alternative to guideline‐directed oral anticoagulation, which remains the cornerstone of stroke prevention in eligible patients with AF.