Circulation. 2001;104:2205-2209
doi: 10.1161/hc4301.098249
doi: 10.1161/hc4301.098249
(Circulation. 2001;104:2205.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Hydroxymethylglutaryl Coenzyme A Reductase Inhibitors on the Progression of Calcific Aortic Stenosis
From the Department of Cardiology (G.M.N., M.S.L., B.P.G.), Department of Internal Medicine (I.Y.T.), and Section of Preventive Cardiology (G.L.P., D.L.S.), The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Brian P. Griffin, MD, Section of Cardiovascular Imaging, F15, 9500 Euclid Ave, Cleveland, OH 44195. E-mail griffib{at}ccf.org
Background— Recent studies have supported the hypothesis that calcific aortic stenosis is the product of an active inflammatory process, with similarities to atherosclerosis. We sought to determine whether therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) might slow the progression of aortic stenosis.
Methods and Results— A retrospective study of 174 patients (mean age 68±12 years) with mild to moderate calcific aortic stenosis was conducted. Patients required normal left ventricular function, 
2+ aortic regurgitation, and 
2 echocardiograms performed at least 12 months apart. Fifty-seven patients (33%) received treatment with a statin; the remaining 117 (67%) did not. The statin group was older and had a higher prevalence of hypertension, diabetes mellitus, and coronary disease. During a mean follow-up of 21 months, patients treated with statin had a smaller increase in peak and mean gradient and a smaller decrease in aortic valve area. When annualized, the decrease in aortic valve area for the nonstatin group was 0.11±0.18 cm2 compared with 0.06±0.16 cm2 for those treated with a statin (P=0.03). In multivariate analysis, statin usage was a significant independent predictor of a smaller decrease in valve area (P=0.01) and a lesser increase in peak gradient (P=0.02).
Conclusions— Statin-treated patients, despite a higher risk profile for progression, had reduced aortic stenosis progression compared with those not treated with a statin. These data provide justification for a prospective randomized trial to substantiate whether statin therapy slows the progression of aortic stenosis.
Key Words: stenosis • cholesterol • statins
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M. F. Bellamy, P. A. Pellikka, K. W. Klarich, A. J. Tajik, and M. Enriquez-Sarano Association of cholesterol levels, hydroxymethylglutaryl coenzyme-a reductase inhibitor treatment, and progression of aortic stenosis in the community J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1723 - 1730. [Abstract] [Full Text] [PDF]
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A. S. Pearlman Medical treatment ofaortic stenosis: Promising, or wishful thinking? J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1731 - 1734. [Full Text] [PDF]
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K. D. O'Brien, D. M. Shavelle, M. T. Caulfield, T. O. McDonald, K. Olin-Lewis, C. M. Otto, and J. L. Probstfield Association of Angiotensin-Converting Enzyme With Low-Density Lipoprotein in Aortic Valvular Lesions and in Human Plasma Circulation, October 22, 2002; 106(17): 2224 - 2230. [Abstract] [Full Text] [PDF]
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 Z. Golbasi, O. Ucar, T. Keles, A. Sahin, K. Cagli, A. Camsari, E. Diker, and S. Aydogdu Increased levels of high sensitive C-reactive protein in patients with chronic rheumatic valve disease: evidence of ongoing inflammation Eur J Heart Fail, October 1, 2002; 4(5): 593 - 595. [Abstract] [Full Text] [PDF]
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 L. L Demer Vascular calcification and osteoporosis: inflammatory responses to oxidized lipids Int. J. Epidemiol., August 1, 2002; 31(4): 737 - 741. [Full Text] [PDF]
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N. M. Rajamannan, M. Subramaniam, M. Springett, T. C. Sebo, M. Niekrasz, J. P. McConnell, R. J. Singh, N. J. Stone, R. O. Bonow, and T. C. Spelsberg Atorvastatin Inhibits Hypercholesterolemia-Induced Cellular Proliferation and Bone Matrix Production in the Rabbit Aortic Valve Circulation, June 4, 2002; 105(22): 2660 - 2665. [Abstract] [Full Text] [PDF]
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B. A. Carabello Evaluation and Management of Patients With Aortic Stenosis Circulation, April 16, 2002; 105(15): 1746 - 1750. [Full Text] [PDF]
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N A Boon and P Bloomfield The medical management of valvar heart disease Heart, April 1, 2002; 87(4): 395 - 400. [Full Text] [PDF]
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B. A. Carabello Aortic Stenosis N. Engl. J. Med., February 28, 2002; 346(9): 677 - 682. [Full Text] [PDF]
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