Key result
In patients with severe aortic stenosis, ACE inhibitor use was associated with decreased valvular expression of tissue factor (13.64% vs 18.05%, p=0.03) and other inflammatory proteins.
Why the study?
Pathobiological similarities between aortic stenosis and atherosclerosis suggested that atherosclerosis therapies might attenuate valvular inflammation, but the effect of ACEIs on valvular coagulation and inflammatory proteins remained unknown.
Does ACEI therapy reduce the valvular expression of coagulation and inflammatory proteins in patients with advanced aortic stenosis?
Cross-Sectional (n=111)
Does ACEI therapy reduce the valvular expression of coagulation and inflammatory proteins in patients with advanced aortic stenosis?
Absolute Event Rate: 13.64% vs 18.05%
p-value: p=0.03
In patients with severe aortic stenosis, ACEI use is associated with lower expression of valvular proteins involved in coagulation and inflammation, suggesting a potential mechanism to attenuate atherosclerosis-like processes in stenotic valves.
Background: Similarities between the pathobiology of aortic stenosis (AS) and atherosclerosis have led to the concept that pharmacological strategies effective in atherosclerosis might attenuate valvular inflammation. Objective: The objective of this study was to assess how angiotensin-converting enzyme inhibitors (ACEIs) might affect valvular expression of coagulation and inflammatory proteins in AS. Material/Methods: We studied 111 advanced AS patients (62 males, aged 63.3±11.2 years) undergoing valve replacement. Plasma levels, valvular expression and mRNA transcripts of tissue factor (TF), TF pathway inhibitor (TFPI), prothrombin, along with C-reactive protein (CRP) and interleukin-6 (IL-6) were evaluated. Results: TF-, TFPI-, CRP and prothrombin valvular expression was not related to demographics, concomitant diseases or plasma TF, free-TFPI or IL-6. ACEIs-treated patients (n=37), mainly due to hypertension (n=24, 65%), showed decreased areas for valvular TF (13.64±6.43 vs. 18.05±6.81%, p=0.03), TFPI (32.6±7.8 vs. 49.15±9.5%, p<0.001), prothrombin (23.47±1.93 vs. 26.61±1.4%, p<0.001), CRP (0.75 [0-9] vs. 1.4 [0-8]%, p=0.009), and IL-6 (3.2±0.65 vs. 6.4±1.83%, p<0.001) compared with non-ACEIs patients. Similarly, patients treated with ACEIs showed lower mRNA expression of TF (1.22±0.47 vs. 2.27±1.42, p=0.041), prothrombin (0.13±0.07 vs. 0.81±0.37, p<0.001), CRP (0.73±0.29 vs. 1.25±0.69, p=0.04), and IL-6 (7.6±5.16 vs. 13.67±7.3, p=0.046). Conclusions: In patients with severe AS, ACEIs use is associated with lower expression of valvular proteins involved in coagulation and inflammation, thus ACEIs therapy could be important in altering atherosclerosis-like processes within stenotic aortic valves.
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Natorska et al. (2018) conducted a cross-sectional in Advanced aortic stenosis (n=111). Angiotensin-converting enzyme inhibitors (ACEIs) vs. Non-ACEIs patients was evaluated on Valvular tissue factor (TF) expression area (p=0.03). In patients with severe aortic stenosis, ACE inhibitor use was associated with decreased valvular expression of tissue factor (13.64% vs 18.05%, p=0.03) and other inflammatory proteins.
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