Abstract 19816: Effect of Diuretics on All-Cause Mortality and Cardiovascular Event Rates in Patients With Asymptomatic Aortic Stenosis
Background: There are very limited data on the safety of cardiovascular drugs in aortic stenosis (AS). We evaluated if diuretics increased the risk of death and cardiovascular events in asymptomatic patients with mild to moderate AS.
Methods: Post-hoc analysis from the Simvastatin and Ezetimibe in Aortic Stenosis study: 1,873 asymptomatic patients with mild to moderate AS and preserved left ventricular ejection fraction (LVEF). Cox multivariable regression was used to assess risk ratios for 1) all-cause mortality, and 2) a composite endpoint (CEP) of 1st myocardial infarction, non-hemorrhagic stroke, heart failure, aortic valve replacement (AVR) or cardiovascular death.
Results: 846 (45%) patients received diuretics. During a median follow-up of 4.3±0.9 years, 545 underwent AVR, 205 died and 688 experienced CEP. In multivariate Cox analysis adjusted for age, gender, blood pressure, cholesterol, estimated glomerular filtration rate, treatment group, ejection fraction, aortic valve area and other medical treatment, diuretics was associated with all-cause mortality (HR: 1.6 [95%CI: 1.7-2.4], p=0.023) and CEP (HR: 1.8 [95%CI: 1.4-2.2], p<0.001). These results were confirmed in propensity adjusted analyses. There was interaction with AS severity (p<0.001).
Conclusions: This secondary analysis suggests that the use of diuretics are associated with higher risk of all-cause mortality and cardiovascular events in patients with AS. A possible mechanism may involve concealment of AS symptoms and under-referral for AVR.
Author Disclosures: A.M. Greve: None. C. Nienaber: None. C. Gohlke-Bärwolf: None. P. Kampaktsis: None. S. Ray: None. R. Willenheimer: None. A. Kesaniemi: None. P.M. Okin: None. R. Devereux: None. K. Wachtell: None. C.N. Bang: None.
- © 2016 by American Heart Association, Inc.