Abstract 16114: Statins Reduce Aortic Valve Metabolic Activity: A Human Multi-Center FDG-PET/CT Study

Abstract

Background: While retrospective studies suggest a beneficial effect of statins on Aortic Valve (AV) stenosis, prospective studies did not. It has been hypothesized that benefit of statins may be limited to patients with existing AV inflammation, which can be assessed in the presence of AS, as well as in structurally normal AV using 18-Flourodeoxyglucose Positron Emission Tomography (FDG-PET). Accordingly, we tested the AV effect of statins in patients with AV inflammation using FDG PET/CT.

Methods: In a multi-center randomized controlled trial, 63 adults without AS, with risk factors for or established atherosclerosis (mean age = 59±10, 76% males) were randomized to 10 vs. 80 mg Atorvastatin and PET/CT imaging was performed at 0, 4 and 12 weeks. AV FDG uptake was evaluated as Standardized Uptake Value (SUV), while blinded to time points and treatment. Patients were dichotomously classified as having or lacking baseline AV inflammation (cut-off = median baseline AV SUV).

Results: At 12 weeks, patients with baseline AV inflammation (n=32) had greater absolute reduction in AV SUV vs. patients without inflammation (n=31) (Median [IQR] = -0.19 [-0.38, 0.10] vs. 0.03 [-0.18, 0.25], p=0.01, fig. A). Further, patients with baseline AV inflammation had significant reduction compared to baseline as early as 4 weeks (Median[IQR]: 1.99 [1.79, 2.20] vs. 2.16[2.06, 2.30], p=0.001), and was maintained at 12 weeks (1.99 [1.76, 2.15] vs. 2.16[2.06, 2.30], p = 0.004, fig. B). Moreover, there was a trend to dose dependent reduction in AV SUV in Atorva. 80 mg group (n = 11) vs. Atorva 10 mg group (n = 20) (Median [IQR]: -0.30 [-0.43, 0.15] vs. -0.13 [-0.36, 0.01], p=0.42). The change in AV inflammation at 12 weeks correlated with change in C-Reactive Protein (hsCRP) (r = 0.36, p = 0.048) but not with change in LDL (r = -0.09, p = 0.48).

Conclusion: The anti-inflammatory effect of statins on AV appears to be limited to patients with AV inflammation, occurs within 4 weeks, and correlates with change in CRP.