Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry

Yashima, Fumiaki; Hara, Masahiko; Inohara, Taku; Jinzaki, Masahiro; Shimizu, Hideyuki; Fukuda, Keiichi; Tanaka, Makoto; Yamamoto, Masanori; Watanabe, Yusuke; Naganuma, Toru; Shirai, Shinichi; Yamawaki, Masahiro; Tada, Norio; Yamanaka, Futoshi; Mizutani, Kazuki; Ueno, Hiroshi; Tabata, Minoru; Takagi, Kensuke; Hayashida, Kentaro

doi:10.1136/bmjopen-2020-044319

Cited by 6 publications

(15 citation statements)

References 28 publications

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“…The leave-one-out analysis showed the studies by Yashima et al 9 and Cubeddo et al 17 to be influential studies. The result of pooled analysis with the influential studies removed, also showed that statins therapy is associated with lower risk of all-cause mortality (HR = .76, 95% CI 0.64–.90, P = .0014; I 2 = 37.7%, Q value = 22.47, P = .0695).…”

Section: Resultsmentioning

confidence: 98%

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Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

et al. 2022

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While TAVI is widely used, optimal medical therapy to reduce the mortality rate after transcatheter aortic valve implantation (TAVI) is still unclear. We performed a systematic review and meta-analysis to evaluate the impact of statins on mortality following TAVI. Present systematic review of the literature was performed using Medline, Embase, Scopus, and Web of Science; all studies reported all-cause mortality in patients who underwent TAVI and received or did not receive statin therapy. Data were analyzed using random-effects models. Seventeen articles (21 380 patients) were included in the meta-analysis. Statin therapy was associated with a reduction of all-cause mortality (Hazard ratio [HR] = .78, 95% Confidence interval [CI] .68–.89, P < .001). Moderate between-study heterogeneity was observed (I2 = 45.2). High-intensity statin therapy was more effective than low or moderate intensity statin therapy in reduction of all-cause mortality (Risk ratio [RR] = .62, 95% CI 0.45–.85, P = .003, I2 = .0). Statin therapy could reduce the mid-term all-cause mortality rate following TAVI. However, all included studies were observational and, therefore, randomized controlled trials are still needed to assess the effect of statin therapy on mortality after TAVI.

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Section: Resultsmentioning

confidence: 98%

“…The flow chart presenting the selection of the articles is shown in (Figure 1). Of included studies, 6 studies reported adjusted HR, 9,10,16,17,19,21 6 studies reported unadjusted HR 11,15,18,23,25,26 and, RRs were calculated for 5 studies. 20,22,24,27,28 The follow-up duration ranged from 12 to 60 months.…”

Section: Resultsmentioning

confidence: 99%

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

et al. 2022

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“…A total of 665 citations were identified, and 210 potentially eligible articles were retrieved in full text. Overall, 54 studies were included in the review ( Figure 1 ) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. Risk of bias assessment using NOS showed that the studies have low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies

Nowak¹,

Niemczyk

Florczyk³

et al. 2022

JCM

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Statins are lipid-lowering medications used for the prevention of cardiovascular disease (CVD), but the pleiotropic effects of statins might be beneficial in other chronic diseases. This meta-analysis investigated the association between statin use and mortality in different chronic conditions. Eligible studies were real-world studies that compared all-cause mortality over at least 12 months between propensity score-matched statin users and non-users. Overall, 54 studies were included: 21 in CVD, 6 in chronic kidney disease, 6 in chronic inflammatory diseases, 3 in cancer, and 18 in other diseases. The risk of all-cause mortality was significantly reduced in statin users (hazard ratio: 0.72, 95% confidence interval: 0.66–0.76). The reduction in mortality risk was similar in CVD studies (0.73, 0.66–0.76) and non-CVD studies (0.70, 0.67–0.79). There were no significant differences in the risk reduction between cohorts with different diseases (p = 0.179). The greatest mortality reduction was seen in studies from Asia (0.61, 0.61–0.73) and the lowest in studies from North America (0.78, 0.73–0.83) and Australia (0.78, 0.62–0.97). There was a significant heterogeneity (I2 = 95%, tau2 = 0.029, p < 0.01). In conclusion, statin use was associated with a significantly reduced risk of all-cause mortality in real-world cohorts with CVD and non-CVD.

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“…However, meta-analyses of observational studies and sub-studies of randomized trials have shown significant associations between statin treatment and better long-term survival in TAVI patients. 14 , 15 , 25 The mechanism is unclear, but it has been speculated that statin therapy reduces the risks of mortality through a reduction of ischaemic events. 25 The results of studies in TAVI populations cannot be directly translated to SAVR patients given that most TAVI patients are markedly older and have more comorbidities than SAVR patients.…”

Section: Discussionmentioning

confidence: 99%

“… 14 , 15 , 25 The mechanism is unclear, but it has been speculated that statin therapy reduces the risks of mortality through a reduction of ischaemic events. 25 The results of studies in TAVI populations cannot be directly translated to SAVR patients given that most TAVI patients are markedly older and have more comorbidities than SAVR patients. In this study, 27.5% of the patients had a diagnosis of hyperlipidaemia and 49.1% were treated with statins at baseline, indicating that a substantial number of patients were prescribed statins because of risk factors and comorbidities other than hyperlipidaemia.…”

Section: Discussionmentioning

confidence: 99%

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

Baranowska

Törngren

Nielsen

et al. 2022

European Heart Journal - Cardiovascular Pharmacotherapy

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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.

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Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry

Cited by 6 publications

References 28 publications

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies

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

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