Abstract 12974: Progression of Early Aortic Valve Disease: Are ACE Inhibitors Protective?
Introduction: Aortic valve stenosis (AS) and its precursor, aortic sclerosis (ASc) occur frequently in Western populations. While clinical interventions with statins have failed to retard AS progression, there is substantial evidence linking activity of the renin-angiotensin system with early aortic valve disease. Furthermore, we have recently shown, in an animal model, that ramipril retards AS/ASc development. In the current study we have evaluated the occurrence and correlates of development and progression of early ASc in an ageing population, utilizing the technique of aortic valve backscatter (AVBS), which facilitates quantification of early valve disease.
Methods: At baseline and after 4 years, 204 randomly selected, ageing subjects (age 63+/-6yrs at study entry) underwent echocardiography with determination of AVBS values, measurements of platelet nitric oxide responsiveness, plasma asymmetric dimethylarginine concentrations, lipid profile, hs-CRP, routine biochemistry, and 25-hydroxyvitamin D levels.
Results: At baseline evaluation 34% and 32% of subjects were being treated with ACE inhibitors/angiotensin II receptor blockers (ACEI/ARB) respectively; 17.6% of subjects had ASc. During 4 year study period, 68% of subjects had detectable AVBS progression and 17.2% developed new ASc. On multivariate analysis, the only predictor of disease progression in the overall cohort was lack of use of ACEI/ARB (β=0.8; p=0.025). In subjects without ASc at baseline (n=160), independent predictors of disease progression were lack of ACEI/ARB therapy (β=1.3; p=0.001) and higher hs-CRP concentrations (β=0.94; p=0.02). No conventional coronary risk factors were associated with disease progression.
Conclusions: This study of early aortic valve disease (1) demonstrates that early disease progression occurs in the majority of the normal ageing population over a 4 year period; (2) reinforces clinical data dissociating progression of ASc from coronary risk factors; (3) provides additional data linking ACEI/ARBs use with retardation of ASc, and (4) reinforces importance of inflammatory activation early in disease process.
- © 2011 by American Heart Association, Inc.