Advertisement

Stage-Related Effect of Statin Treatment on the Progression of Aortic Valve Sclerosis and Stenosis

      It has been suggested that statins could slow the progression of aortic stenosis (AS), but this hypothesis is still debated and has not been validated in large series of patients by long-term follow-up studies. Moreover, information about the role of statins in patients with different degrees of severity of AS is scarce. From our 1988 to 2007 echocardiographic database, we retrospectively identified all asymptomatic patients with aortic valve sclerosis (abnormal irregular thickening of the aortic valve with a peak aortic velocity [Vmax] ≥1.5 and <2 m/s), mild AS (Vmax ≥2 and <3 m/s), and moderate AS (Vmax ≥3 and <4 m/s), age ≥50 years, and with ≥2 echocardiographic studies ≥2 years apart. Exclusion criteria were moderate/severe aortic regurgitation, bicuspid aortic valve, rheumatic valve disease, and ejection fraction <40%. The final study population consisted of 1,046 patients (mean age 70 ± 8 years, 587 men); 309 were treated with statins. Mean follow-up duration was 5.6 ± 3.2 years (range 2 to 19). Progression of AS was slower in patients receiving statins compared with untreated patients in aortic sclerosis (0.04 ± 0.09 vs 0.07 ± 0.10 m/s/year, p = 0.01) and mild AS (0.09 ± 0.15 vs 0.15 ± 0.15 m/s/year, p = 0.001), but not in moderate AS (0.21 ± 0.18 vs 0.22 ± 0.15 m/s/year, p = 0.70). In multivariate analysis only statin therapy, initial Vmax, and dialysis were independently related to progression of aortic valve disease. In conclusion, in a large series of patients with long-term follow-up, statins were effective in slowing the progression of aortic valve disease in aortic sclerosis and mild AS, but not in moderate AS. These results suggest that statin therapy should be taken into consideration in the early stages of this common disease.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stewart B.F.
        • Siscovick D.
        • Lind B.K.
        • Gardin J.M.
        • Gottdiener J.S.
        • Smith V.E.
        • Kitzman D.W.
        • Otto C.M.
        Clinical factors associated with calcific aortic valve disease: Cardiovascular Health Study.
        J Am Coll Cardiol. 1997; 29: 630-634
        • Bonow R.O.
        • Carabello B.A.
        • Chatterjee K.
        • de Leon Jr, A.C.
        • Faxon D.P.
        • Freed M.D.
        • Gaasch W.H.
        • Lytle B.W.
        • Nishimura R.A.
        • O'Gara P.T.
        • et al.
        ACC/AHA 2006 guidelines for the management of patients with valvular heart disease.
        J Am Coll Cardiol. 2006; 48: e1-e148
        • Aronow W.S.
        • Ahn C.
        • Kronzon I.
        • Goldman M.E.
        Association of coronary risk factors and use of statins with progression of mild valvular aortic stenosis in older persons.
        Am J Cardiol. 2001; 88: 693-695
        • Bellamy M.F.
        • Pellikka P.A.
        • Klarich K.W.
        • Tajik A.J.
        • Enriquez-Sarano M.
        Association of cholesterol levels, hydroxymethylglutaryl coenzyme-A reductase inhibitor treatment, and progression of aortic stenosis in the community.
        J Am Coll Cardiol. 2002; 40: 1723-1730
        • Novaro G.M.
        • Tiong I.Y.
        • Pearce G.L.
        • Lauer M.S.
        • Sprecher D.L.
        • Griffin B.P.
        Effect of hydroxymethylglutaryl coenzyme A reductase inhibitors on the progression of calcific aortic stenosis.
        Circulation. 2001; 104: 2205-2209
        • Rosenhek R.
        • Rader F.
        • Loho N.
        • Gabriel H.
        • Heger M.
        • Klaar U.
        • Schemper M.
        • Binder T.
        • Maurer G.
        • Baumgartner H.
        Statins but not angiotensin-converting enzyme inhibitors delay progression of aortic stenosis.
        Circulation. 2004; 110: 1291-1295
        • Moura L.M.
        • Ramos S.F.
        • Zamorano J.L.
        • Barros I.M.
        • Azevedo L.F.
        • Rocha-Goncalves F.
        • Rajamannan N.M.
        Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis.
        J Am Coll Cardiol. 2007; 49: 554-561
        • Cowell S.J.
        • Newby D.E.
        • Prescott R.J.
        • Bloomfield P.
        • Reid J.
        • Northridge D.B.
        • Boon N.A.
        A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis.
        N Engl J Med. 2005; 352: 2389-2397
        • Otto C.M.
        Why is aortic sclerosis associated with adverse clinical outcomes?.
        J Am Coll Cardiol. 2004; 43: 176-178
        • Cosmi J.E.
        • Kort S.
        • Tunick P.A.
        • Rosenzweig B.P.
        • Freedberg R.S.
        • Katz E.S.
        • Applebaum R.M.
        • Kronzon I.
        The risk of development of aortic stenosis in patients with “benign” aortic valve thickening.
        Arch Intern Med. 2002; 162: 2345-2347
        • Douglas P.S.
        • Khandheria B.
        • Stainback R.F.
        • Weissman N.J.
        Appropriateness criteria for transthoracic and transesophageal echocardiography.
        J Am Coll Cardiol. 2007; 50: 187-204
        • Antonini-Canterin F.
        • Popescu B.A.
        • Huang G.
        • Korcova-Miertusova R.
        • Rivaben D.
        • Faggiano P.
        • Pavan D.
        • Piazza R.
        • Bolis A.
        • Ciavattone A.
        • Ruggiero A.
        • Nicolosi G.L.
        Progression of aortic valve sclerosis and aortic valve stenosis: what is the role of statin treatment?.
        Ital Heart J. 2005; 6: 119-124
        • Cheitlin M.
        • Armstrong W.F.
        • Aurigemma G.P.
        • Beller G.A.
        • Bierman F.Z.
        • Davis J.L.
        • Douglas P.S.
        • Faxon D.P.
        • Gillam L.D.
        • Kimball T.R.
        • et al.
        ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography).
        J Am SocEchocardiogr. 2003; 16: 1091-1110
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Rossebø A.B.
        • Pedersen T.R.
        • Allen C.
        • Boman K.
        • Chambers J.
        • Egstrup K.
        • Gerdts E.
        • Gohlke-Barwolf C.
        • Holme I.
        • Kesaniemi V.A.
        • et al.
        Design and baseline characteristics of the simvastatin and ezetimibe in aortic stenosis (SEAS) study.
        Am J Cardiol. 2007; 99: 970-973
        • Chan K.L.
        • Teo K.
        • Tam J.
        • Dumesnil J.G.
        Rationale, design, and baseline characteristics of a randomized trial to assess the effect of cholesterol lowering on the progression of aortic stenosis: The Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin (ASTRONOMER) trial.
        Am Heart J. 2007; 153: 925-931
        • Liebe V.
        • Brueckmann M.
        • Borggrefe M.
        • Kaden J.J.
        Statin therapy of calcific aortic stenosis: hype or hope?.
        Eur Heart J. 2006; 27: 773-778
        • Griffin B.P.
        Statins in aortic stenosis.
        J Am Coll Cardiol. 2007; 49: 562-564
        • Goldbarg S.H.
        • Elmariah S.
        • Miller M.A.
        • Fuster V.
        Insights into degenerative aortic valve disease.
        J Am Coll Cardiol. 2007; 50: 1205-1213
        • Otto C.M.
        • O'Brien K.D.
        Why is there discordance between calcific aortic stenosis and coronary artery disease?.
        Heart. 2001; 85: 601-602
        • Otto C.M.
        • Lind B.K.
        • Kitzman D.W.
        • Gersh B.J.
        • Siscovick D.S.
        Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly.
        N Engl J Med. 1999; 341: 142-147