Abstract 3112: The Effect of Angiotensin-Converting Enzyme Inhibition on Progression of Aortic Sclerosis and Mortality
Introduction: Aortic sclerosis has many risk factors in common with atherosclerosis and is associated with an increased risk of cardiovascular death. We assessed the hypothesis that treatment with angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) may improve outcome of patients with aortic sclerosis.
Methods: We identified 1,117 consecutive patients with aortic sclerosis (defined as thickening or calcification with a mean valve gradient < 15 mmHg on echocardiography) who had a follow-up echocardiogram at least 180 days later at one of three VA laboratories. Patients were excluded if they had no prescriptions within 150 days of the initial echocardiogram (n=25). The primary outcome was survival free of aortic stenosis.
Results: The mean age of the 1092 patients was 71 ± 10 years, 52% had prior ischemic heart disease, 80% had hypertension, and 35% had diabetes. Progression (defined as an increase in mean gradient to over 15 mmHg or aortic valve replacement) occurred in 64 (6%) patients during a mean follow-up of 1078 ± 615 days. Among 645 patients treated with ACE-Is or ARBs, unadjusted mortality (20% ACE-I or ARB vs. 23% none, p=0.42) and progression to stenosis (5% ACEI-ARB vs. 8% none, p=0.17) were similar. However, after adjustment for the propensity to receive an ACE-I or ARB (including clinical characteristics, echocardiographic findings and laboratory values) death or progression to stenosis was significantly less for patients treated with ACE-Is or ARBs (odds ratio 0.56, 95% CI 0.40 – 0.78, p-0.001, Figure⇓).
Conclusion: ACE-I or ARB treatment of patients with aortic valve sclerosis is associated with improved outcome