What is the clinical evidence from this study?

Study design: Observational. Population: Degenerative aortic valve disease (n=359). Intervention: Warfarin use vs. Non-use of warfarin. Primary outcome: Annualized changes in aortic valve area indexed to body surface area (ΔiAVA, cm2/m2/year) (p=0.026).

January 1, 2015Open Access

Risk Factors for Progression of Degenerative Aortic Valve Disease in the Japanese　– The Japanese Aortic Stenosis Study (JASS) Prospective Analysis –

KYKazuhiro YamamotoHiroshima University HYHideya YamamotoYasuda Women's University MTMasaaki TakeuchiCardiac Imaging

Key Result

In Japanese patients with degenerative aortic valve disease, the use of warfarin was associated with a significantly greater annualized reduction in indexed aortic valve area compared to non-use.

Study Design

Type

Observational (n=359)

Multicenter

Yes

Structured PICO

Population

359 Japanese adults aged 50 years or older with degenerative aortic valve disease, followed prospectively for a mean of 2.4 years.

Outcome

Progression of degenerative aortic valve disease assessed by annualized changes in aortic valve area indexed to body surface area (∆iAVA) and annualized changes in peak aortic transvalvular flow velocity over a mean follow-up of 2.4 years.surrogate

In Japanese patients with degenerative aortic valve disease, warfarin use may exacerbate progression, while ARBs or ACEIs may slow progression depending on disease stage, and traditional atherosclerotic risk factors do not predict progression.

Main Result

Absolute Event Rate: -0.075% vs -0.036%

p-value: p=0.026

Limitations

Observational and hospital-based study design may introduce selection bias.
Baseline characteristics of patients treated with and without each medicine were not comparable.
Sample size was not large enough to perform propensity matching to adjust for baseline differences.
Duration of exposure to atherosclerotic risk factors was not taken into account.

Abstract

BACKGROUND: Because of ethnic difference in the risk of degenerative aortic valve disease (DAVD), risk factors should be clarified in each race to establish prophylactic strategies for severe aortic valve stenosis (AS). METHODS AND RESULTS: This study prospectively followed 359 Japanese subjects with DAVD and age ≥50 years for 3 years. As both patients with peak aortic transvalvular flow velocity ≥2 m/s and <2 m/s were enrolled, subgroup analysis was also conducted. Most patients were under treatment for their comorbidities. The use of warfarin, but none of the traditional risk factors for atherosclerosis, was related to greater reduction in aortic valve area indexed to body surface area (iAVA). In patients with peak aortic transvalvular flow velocity <2 m/s, the use of an angiotensin-receptor blocker (ARB) was associated with less decrease in iAVA. In patients with peak velocity ≥2 m/s, changes in iAVA were not related to any baseline characteristics, but peak velocity was less increased under treatment with an angiotensin-converting enzyme inhibitor (ACEI). CONCLUSIONS: In Japanese, the use of warfarin may exacerbate DAVD, and augmented management of atherosclerotic risk factors beyond the recommendations in the current guidelines is unlikely to exert additional benefit. The prescription of ARB for DAVD patients before the development of AS or ACEI after the development of AS may be useful.

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