Rosuvastatin Affecting Aortic Valve Endothelium to Slow the Progression of Aortic Stenosis

Moura, Luís M; Ramos, Susana; Zamorano, José Luís; Barros, Isabel M; Azevedo, Luís Filipe; Rocha-Gonçalves, Francisco; Rajamannan, Nalini M.

doi:10.1016/j.jacc.2006.07.072

Cited by 347 publications

(215 citation statements)

References 47 publications

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“…Previous studies have also reported an association of elevated serum LDL‐C with development and faster progression of AS 6, 46, 47, 48. In the present study, higher apoB/apoA‐I ratio was associated with faster AS progression independently of the level of LDL‐C, which did not reach significance level.…”

Section: Discussioncontrasting

confidence: 92%

ApoB/ApoA‐I Ratio is Associated With Faster Hemodynamic Progression of Aortic Stenosis: Results From the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) Study

Tastet

Capoulade

Shen

et al. 2018

JAHA

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BackgroundPrevious studies reported that middle‐aged patients with atherogenic lipoprotein‐lipid profile exhibit faster progression of aortic valve stenosis (AS). The ratio of apolipoprotein B/apolipoprotein A‐I (apoB/apoA‐I) reflects the balance between atherogenic and anti‐atherogenic lipoproteins. The aim of this study was to examine the association between apoB/apoA‐I ratio and AS hemodynamic progression and to determine whether this association varies according to age.Methods and ResultsA total of 159 patients (66±13 years, 73% men) with AS were prospectively recruited in the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study. Hemodynamic progression of AS was determined by the change in peak aortic jet velocity (Vpeak) measured by Doppler‐echocardiography between baseline and 2‐year follow‐up. Patients in the top tertile of apoB/apoA‐I ratio (≥0.62) had a faster progression rate of AS compared with those in the bottom/mid tertiles (Vpeak progression: 0.30 [0.09˗0.49] versus 0.16 [0.01˗0.36] m/s, P=0.02). There was a significant interaction (P=0.007) between apoB/apoA‐I ratio and age. Among younger patients (ie, aged <70 years; median value of the cohort), those in the top tertile of apoB/apoA‐I ratio had a 3.4‐fold faster AS progression compared with those in the bottom/mid tertiles (Vpeak progression: 0.34 [0.13˗0.69] versus 0.10 [−0.03˗0.31] m/s, P=0.002), whereas there was no significant difference between tertiles in the subgroup of older patients (P=0.83). After comprehensive adjustment, higher apoB/apoA‐I ratio was significantly associated with faster AS progression in the subset of younger patients (all, standardized β≥0.36; P≤0.01).ConclusionsHigher apoB/apoA‐I ratio is significantly associated with faster hemodynamic progression of AS in the younger patients. These findings suggest that atherogenic lipid factors may play a crucial role in the pathogenesis of AS in younger patients, but may be are less important in older patients.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01679431.

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Section: Discussioncontrasting

confidence: 92%

ApoB/ApoA‐I Ratio is Associated With Faster Hemodynamic Progression of Aortic Stenosis: Results From the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) Study

Tastet

Capoulade

Shen

et al. 2018

JAHA

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“…Moura et al 37 reported the attenuated progression of aortic stenosis in patients who received rosuvastatin because their low-density lipoprotein levels were 4130 mg per 100 ml at baseline, compared with those who did not receive rosuvastatin because their baseline low-density lipoprotein was o130 mg per 100 ml; in addition, the greater decrease in low-density lipoprotein was associated with less progression of aortic stenosis in the rosuvastatin-treated patients. Recent clinical trials failed to find beneficial effects of pharmacological lipid-lowering therapy in preventing progression of aortic stenosis in patients for whom lipid-lowering therapy is not indicated according to current guidelines.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Yamamoto

Yoshida

et al. 2010

Hypertens Res

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Calcific aortic valve disease (CAVD) is the most common etiology of acquired valvular heart disease, and hypertension is a principal underlying disease. The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis is a retrospective observational study to clarify the prognostic factors for progression of CAVD in Japanese. Data from 556 subjects who met the following criteria were analyzed: (1) X50 years old; (2) calcification in any aortic valve leaflet or peak aortic jet velocity X2 m s À1 on an echocardiographic study performed between July 2004 and June 2007; and (3) availability of earlier echocardiographic data from within the previous 2-5 years to assess the progression of CAVD. The subjects were divided into two groups according to CAVD severity on the preceding echocardiographic examination. In early-stage subjects with calcification in one or zero leaflets who were without aortic stenosis on the preceding echocardiographic study (n¼157), the prognostic factors for progression were the following: (1) no use of angiotensin receptor blockers (ARB) and (2) use of warfarin. In late-stage subjects with calcification in two or three leaflets and/or aortic stenosis on the preceding echocardiographic study (n¼399), progression was observed in females and in subjects with low hemoglobin and a concentric left ventricle. There was no relation between medications and changes in CAVD. Prognostic factors for the progression of CAVD were different between the early and late stages. Initiation of ARB treatment during the early stage may be effective, and we should be vigilant about progression of CAVD in patients treated with warfarin.

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“…First, in the retrospective studies, statins were used in the setting of hypercholesterolaemia, whereas in the prospective randomized trials patients with hypercholesterolaemia were generally excluded. This can also explain the positive findings of the prospective but non-randomized RAAVE trial, in which only AS patients with hypercholesterolaemia were treated with rosuvastatin 26 . In fact, the population of the majority of prospective studies does not reflect the "real world" in which "pure" calcific AS without any "atherosclerotic" co-morbidity is very rare and possibly based on other pathogenetic mechanisms.…”

Section: Discussionmentioning

confidence: 89%

“…They suggested that earlier initiation of statin therapy may be the key to success in the future. The only prospective but non-randomized study to demonstrate a positive effect of statins on reducing AS progression was the RAAVE trial 26 . The aim was to assess the effect of statin therapy on the haemodynamic progression of calcific moderate to severe AS and on the inflammatory biomarkers that have been described clinically to affect the aortic valve endothelium.…”

Section: Lipidsmentioning

confidence: 99%

The role of statin treatment in valvular heart disease: is the jury still out?

et al. 2013

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Valvular heart disease (VHD) represents a signifi cant burden within the spectrum of cardiovascular diseases. In recent years, there has been a great interest in fi nding medical treatments able to slow the progression of VHD. The negative results of several large randomized trials failing to demonstrate a benefi t of such therapies, has led to a decrease of interest in this fi eld. However, fi nding a medical treatment capable of preventing VHD progression is still a hot topic, due to the important clinical implications. We believe that the jury is still out on the debate about the role of statin therapy in VHD, considering also recently published studies providing new information with future implications for the treatment of this disease process. This article gives an overview of the published evidence about the role of hydroxymethylglutaryl coenzyme-A reductase inhibitors on delaying progressive valve dysfunction. A preventive therapy, which could infl uence not only the haemodynamic progression of valve disease, but also the cardiovascular outcome, is warranted. Large, prospective, randomized trials are needed to properly evaluate the role of statins in the early stages of valvular heart disease.

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Rosuvastatin Affecting Aortic Valve Endothelium to Slow the Progression of Aortic Stenosis

Cited by 347 publications

References 47 publications

ApoB/ApoA‐I Ratio is Associated With Faster Hemodynamic Progression of Aortic Stenosis: Results From the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) Study

ApoB/ApoA‐I Ratio is Associated With Faster Hemodynamic Progression of Aortic Stenosis: Results From the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) Study

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

The role of statin treatment in valvular heart disease: is the jury still out?

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