Abstract
Background
Aortic stenosis (AS) is believed to develop through an inflammatory similar to the
atherosclerosis process. Based on findings from animal studies and uncontrolled clinical
studies, lipid-lowering therapy with a statin is postulated to slow this process.
Randomized trials, however, reported neutral results. This meta-analysis of randomized
lipid trials on patients with AS examined the effects of treatment on AS progression
and clinical outcomes.
Methods
Echocardiographic measures of AS (aortic valve jet velocity, peak and mean valve gradients,
and aortic valve area) were pooled and clinical outcomes were evaluated in 4 randomized
placebo controlled trials (N = 2344).
Results
Although active treatment with statin therapy was associated with highly significant
50% reduction in low-density lipoprotein cholesterol levels, there were no statistical
differences between active and placebo groups in any of the echocardiographic indicators
of AS severity: annual increase in AS velocity was 0.16 ± 0.28 m/sec, and mean gradient
was 2.8 ± 3.0 mm Hg. Each trial reported no differences in clinical outcomes between
the 2 treatment groups. Substantial events rates (6.6% aortic valve surgery and 1.2%
cardiovascular deaths per year in SEAS with follow-up of 4.4 years and 5.8% aortic
valve surgery and 0.7% cardiovascular deaths per year in ASTRONOMER over 3.5 years)
were observed in these patients despite the relatively mild disease.
Conclusion
The current data do not support the hypothesis that statin therapy reduces AS progression.
Patients with mild to moderate AS may require closer follow-up because despite the
less severe disease in these trials, event rates remain substantial.
Résumé
Introduction
L'on croit que la sténose aortique (SA) se développe par une inflammation similaire
au processus de l'athérosclérose. Selon les découvertes provenant d'études sur des
animaux et d'études cliniques non comparatives, le traitement hypolipidémiant avec
une statine est présumé ralentir le processus. Cependant, des essais aléatoires ont
rapporté des résultats neutres. Cette métaanalyse d'essais aléatoires sur les lipides
avec des patients ayant une SA ont examiné les effets du traitement sur la progression
de la SA et les résultats cliniques.
Méthodes
Les mesures échocardiographiques de la SA (vitesse du jet de la valve aortique, pic
et gradients moyens de la valve, et la zone de la valve aortique) ont été regroupées,
et les résultats cliniques ont été évalués dans 4 essais comparatifs avec placebo
aléatoires (N = 2344).
Résultats
Même si un traitement actif par statine a été associé à une réduction hautement significative
de 50 % des niveaux de cholestérol à lipoprotéines de basse densité, il n'y a eu aucune
différence statistique dans tous les indicateurs échocardiographiques de la sévérité
de la SA entre les groupes actifs et placebo. L'augmentation annuelle de la vitesse
de la SA a été de 16 ± 0,28 m/s, et le gradient moyen a été de 2,8 ± 3,0 mmHg. Tous
les essais n'ont rapporté aucune différence dans les résultats cliniques entre les
2 groupes de traitement. Les taux d'événements importants (6,6 % de chirurgie de valve
aortique et 1,2 % de mortalité cardiovasculaire par année selon SEAS avec un suivi
à 4,4 ans, et 5,8 % de chirurgie de valve cardiaque et 0,7 % de mortalité cardiovasculaire
par année selon ASTRONOMER au-delà de 3,5 ans) ont été observés chez ces patients
en dépit de la maladie relativement bénigne.
Conclusion
Les données actuelles ne supportent pas l'hypothèse selon laquelle la thérapie aux
statines réduit la progression de la SA. Les patients avec une SA faible à modérée
ont besoin d'un suivi plus serré parce qu'en dépit d'une maladie moins sévère dans
ces essais, les taux d'événements demeurent importants.
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Article info
Publication history
Published online: July 11, 2011
Accepted:
March 16,
2011
Received:
February 18,
2011
Footnotes
See page 807 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
