Background: Renin-angiotensin-aldosterone system and inflammation have been reported to influence endothelial function, prothrombotic and hypercoagulable state and maintenance of atrial fibrillation (AF). However, it is not certain whether angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), statin may improve endothelial dysfunction and prothrombotic condition and reduce thromboembolism (TE) in patients with persistent and permanent AF. Methods: All patients had more than 1 known risk factor for TE and were divided into 4 groups. Group I (n=10, M:F=6:4, 49짹6 years) was treated without ACEI, ARB, statin, group II (n=9, M:F=7:2, 48짹6 years) with only ACEI or ARB, group III with only statin (n=15, M:F=8:7, 49짹7 years) and group IV (n=17, M:F=11:6, 45짹3 years) with combination of ACEI or ARB and statin. Markers for endothelial function (von-Willebrand factor, vWF; factor 8 related antigen and ristocetin cofactor), inflammation [white blood cell counts, erythrocyte sedimentation rate, quantitative and high sensitivity C-reactive protein (CRP)] and coagulation system (fibrinogen, fibrinogen degradation product, fibrin d-dimer) were measured at baseline state and at 6 month follow-up. Antithrombotic therapy was done in all patients according to ACC/AHA guideline. Results: The TE did not occur in all groups during 6 month follow-up. There were no significant differences in levels of each marker at baseline state. There were no significant changes in group I and group II at 6 month follow-up. vWF-factor 8 related antigen was significantly reduced at 6 month (172짹43% vs. 110짹41%, p=0.001) in group III. vWF-factor 8 related antigen and fibrinogen were significantly reduced at 6 month in group IV (184짹52% vs. 150짹68%, p=0.021; 331짹73 vs. 275짹57, p=0.047, respectively). Other markers were not changed significantly in all groups. Conclusions: Statin is considered most effective in improving endothelial function and combination of statin with ACEI or ARB might have additional effect on coagulation system in patients with persistent and permanent AF.