Lipid-lowering therapy in calcific aortic stenosis

• Main Author: Cowell, Sarah Joanna
• Published: University of Edinburgh 2008
• Subjects: 616.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.645063

We hypothesised that (a) risk factors for atherosclerosis would predict, and (b) lipid lowering therapy would retard, disease progression and clinical outcome in patients with calcific aortic stenosis. Objectives: In patients with aortic stenosis, (i) to compare the magnitude and reproducibility of measures of valvular stenosis and calcification, (ii) to determine the effect of intensive lipid lowering therapy on disease progression and clinical outcome, and (iii) to describe predictors of disease progression and clinical outcome. Methods: In the Scottish Aortic stenosis and Lipid lowering Therapy, Impact on Regression (SALTIRE) trial, 155 patients aged 68±11 years (range 34-85) with aortic valve stenosis underwent helical computed tomography and Doppler echocardiography. In a double blind randomised controlled trial, 77 patients were assigned to atorvastatin 80 mg daily and 78 to matched placebo over a medium period of 25 months. Of the 155 patients, 102 had detectable coronary artery calcification on computed tomography with 48 of these patients being randomised to atorvastatin and 54 to placebo. Conclusions: Calcification of the aortic valve is closely associated with the severity of aortic stenosis with heavy calcification suggesting the presence of severe aortic stenosis that requires urgent cardiological assessment. In contrast to observational studies, intensive lipid-lowering therapy does not halt the progression or induce regression of aortic stenosis or coronary artery calcification. Long-term, large-scale, randomised, controlled trials are needed to establish the role of statin therapy in patients with calcific aortic stenosis. The major predictors of disease progression and clinical outcome remain baseline measures of disease severity; namely aortic-jet velocity, aortic valve calcification and serum BNP concentration. With the exception of hypertension the presence of atherosclerotic risk factors and vascular disease are not predictive. Our findings suggest that atherogenesis does not provide a major contribution to the progression of aortic stenosis.