Abstract 3235: Statins and Nonrheumatic Calcific Aortic Stenosis: A Meta-analysis on Outcomes and Disease Progression
BACKGROUND: whether statin treatment improves hard outcomes and reduces aortic stenosis progression in nonrheumatic calcific aortic stenosis is unclear.
METHODS AND RESULTS: We undertook a meta-analysis of prospective and retrospective trials reporting the effect of statin therapy on the hard outcomes (all-cause mortality, cardiovascular mortality and need of aortic valve surgery at follow-up) and on valve stenosis progression (annualized rates of jet velocity progression and of aortic valve area decrease) in patients affected by calcific nonrheumatic aortic stenosis. Electronic bibliographic databases, key journals and reference lists of reviews and articles were searched to identify studies for inclusion. Data were analyzed using both fixed and random-effects models. Heterogeneity among trials was examined using the Q statistic and I2 methods. A predefined subgroup analysis assessed the effect of statin treatment on prospective and retrospective trials. We selected 7 trials (3 prospective, 4 retrospective) involving 3107 participants (2037 non statin-treated and 1430 statin-treated). No significant differences were found for all-cause mortality (OR 0.98; 95% CI 0.74, 1.30), cardiovascular mortality (OR 0.83; 95% CI 0.56, 1.22), and for the need of aortic valve surgery (OR 0.90; 95% CI 0.75, 1.09) at follow-up. Aortic valve stenosis progression was significantly reduced by statin treatment, being the mean annual difference of jet velocity progression (−0.07 m/s/y; 95%CI −0.12, −0.02; p=0.003) and the mean annual difference in aortic valve area decrease (−0.03 cm2/y; 95%CI −0.05, 0.00; p=0.04) both in favor of statin treatment. These results were, however, weakened by substantial heterogeneity in the models for both variables, and by publication bias at funnel plots. Finally, subgroup analysis showed that statin effect was evident only in retrospective but not in prospective trials.
CONCLUSIONS: currently available data weakly support statin use to reduce disease progression in nonrheumatic calcific aortic valve stenosis.