Statin Use and Aneurysm Risk in Patients With Bicuspid Aortic Valve Disease

Abstract

Background: No medical therapy has been proven to prevent the progression of aortic dilatation in bicuspid aortic valve (BAV) disease, and prophylactic aortic surgery remains the mainstay of treatment. Hypothesis: Among patients with BAV disease who are referred for surgery, preoperative statin use is associated with decreased odds of ascending aortic dilatation. Methods: We reviewed all BAV patients who underwent aortic valve and/or aortic surgery at our center between April 2004 and December 2013. Aortic diameter (AD), defined as the maximum ascending aortic dimension, was determined by magnetic resonance imaging, computed tomography, or echocardiography. Patients were divided into 2 groups: maximal AD <4.5 cm or ≥4.5 cm. The association between preoperative statin use and aortic dilatation was assessed using multivariable logistic regression modeling. Results: Of 680 consecutive patients, 405 (60%) had AD <4.5 cm (mean age, 60 ± 14 years; 45% on statins), whereas 275 (40%) had AD ≥4.5 cm (mean age, 54 ± 13 years; 35% on statins) at the time of surgery. After adjusting for age, body surface area, sex, hypertension, aortic stenosis, severity of aortic regurgitation, and use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers, patients with AD ≥4.5 cm had 0.66× lower odds (95% confidence interval: 0.45-0.96) of being on preoperative statins compared with those with AD <4.5 cm (P = 0.029). Conclusions: In a retrospective study of BAV patients referred for surgery, preoperative statin use was associated with lower odds of clinically significant ascending aortic dilatation.

DNA Methylation Analysis of Turner Syndrome BAV

“…Studies of BAV in the euploid population have linked increased cholesterol levels in BAV patients with aortic stenosis and linear correlation of low-density lipoprotein levels and ascending aorta diameter ( Alegret et al, 2015 ; Endo et al, 2015 ). BAV patients undergoing statin treatment were observed to have reduced progression of aortopathy following heart surgery, which was not found in the TAV counterparts ( Taylor et al, 2016 ; Sequeira Gross et al, 2018 ). An interesting connection can be found when we consider that TS individuals are at an increased risk for dyslipidemia which presents at an early age, although cholesterol levels improve following hormone replacement therapy ( Ross et al, 1995 ; Mavinkurve and O'Gorman, 2015 ).…”

Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve

“…Michelena et al [7], in a community study, showed age, dyslipidemia and the presence of raphe to be associated with valve degeneration. Based on these findings, control of cardiovascular risk factors and some pharmacologic treatment such as statin therapy could be beneficial and reduce or delay degeneration of the BAV [30]. Mechanisms of progression to severe aortic dysfunction are poorly understood and merit future studies for the factors leading to this less frequent but major complication to be determined.…”

A Retrospective Observational Study to Assess Prescription Pattern in Patients with Type B Aortic Dissection and Treatment Outcome

“…There are many studies that have investigated the relationship between statins, aortic aneurysm, and aortic dissection. Taylor et al [ 22 ] found that preoperative statin use was associated with a lower risk of ascending aortic dilatation in patients with a bicuspid aortic valve. Angeloni et al [ 23 ] retrospectively reviewed 1348 patients in an outpatient clinic from September 2005 to December 2011 and they showed that a statin treatment was associated with a reduced growth rate of ascending aorta aneurysms.…”