Associations between medical therapy after surgical aortic valve replacement for aortic stenosis and long-term mortality: a report from the SWEDEHEART registry

Abstract

Aims The association between use of statins, renin-angiotensin system (RAS) inhibitors and/or β-blockers and long-term mortality in patients with aortic stenosis who underwent surgical aortic valve replacement (SAVR) is unknown. Methods and results All patients with aortic stenosis who underwent isolated first time SAVR in Sweden from 2006 to 2017 and survived six months after discharge were included. Individual patient data from four mandatory nationwide registries were merged. Cox proportional hazards models, with time-updated data on medication status and adjusted for age, sex, comorbidities, type of prosthesis, and year of surgery, were used to investigate associations between dispensed statins, RAS inhibitors, and β-blockers, and all-cause mortality. In total, 9553 patients were included, and median follow-up time was 4.9 years (range 0–11); 1738 patients (18.2%) died during follow-up. Statins were dispensed to 49.1% and 49.0% of the patients within six months of discharge from hospital and after ten years, respectively. Corresponding figures were 51.4% and 53.9% for RAS inhibitors, and 79.3% and 60.7% for β-blockers. Ongoing treatment was associated with lower mortality risk for statins [adjusted hazard ratio (aHR) 0.67 (95% confidence interval 0.60–0.74), p < 0.001] and RAS inhibitors [aHR 0.84 (0.76–0.93), p < 0.001] but not for β-blockers [aHR 1.17 (1.05–1.30), p = 0.004]. The associations were robust in subgroups based on age, sex, and comorbidities (p for interactions > 0.05). Conclusions The results of this large population-based real-world study support the use of statins and RAS inhibitors for patients who underwent SAVR due to aortic stenosis.

The clinical outcomes of reni-angiotensin system inhibitors for patients after transcatheter aortic valve replacement: A systematic review and meta-analysis

“…Magne et al showed that RAS inhibitors were associated with improved clinical outcomes for patients after SAVR ( 32 ). The results from a recent large real-world population-based study supported the use of RAS inhibitors for patients after SAVR due to AS ( 33 ). Three previous systematic reviews and meta-analysis ( 34 – 36 ) explored the impact of RAS inhibitors on patients after AVR (TAVR and/or SAVR), and demonstrated that RAS inhibitors could lower the all-cause mortality rate for patients after AVR.…”

Renin–angiotensin system inhibition after surgical aortic valve replacement for aortic stenosis

“…[10][11][12] RAS inhibitors have been shown to be associated with improved outcome after TAVI, 13 but there are no large longterm studies after SAVR, except a recent study where associations between different secondary prevention medications and mortality were investigated. 14 In that study, an association between RAS inhibition and lower all-cause mortality was observed. In the current study, partly based on the same patient cohort, we aimed to evaluate if there is an association between RAS inhibition and major adverse cardiovascular events (MACEs) after SAVR, if there are subgroups of SAVR patients with more noticeable associations for any of the endpoints and if potential associations with long-term outcomes differ between ACE inhibitors and ARBs.…”

Lipoprotein (a) and lipid-lowering treatment from the perspective of a cardiac surgeon. An impact on the prognosis in patients with aortic valve replacement and after heart transplantation

“…Based on information from Refs. [ [1] , [2] , [3] , [4] , [5] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [32] , [33] , [34] , [35] , [36] , [37] , [44] , [45] , [46] , [47] , [48] , [49] , [50] ]. The elements of the figure were created using SERVIER MEDICAL ART (CC BY 4.0).…”

“…It was also shown that the use of statins in patients undergoing SAVR reduced the risk of all-cause mortality (HR = 0.67; 95 % CI: 0.60–0.74). The use of statins does not affect the risk of AS [ 24 ]. In a study including 11894 patients after SAVR, it was found that ongoing statin treatment led to a reduced risk of: all-cause mortality (HR adj = 0.70; 95 % CI: 0.64–0.76), cardiovascular mortality (HR adj = 0.86; 95 % CI: 0.77–0.97) and MACE (HR adj = 0.77; 95 % CI: 0.71–0.83).…”