What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic valve sclerosis (n=541). Intervention: Statins vs. Non-statin-treated. Primary outcome: Progression rate of aortic valve sclerosis (increase in peak velocity per year, m/s/yr) (p=0.956).

What does this research mean for the field?

Statin treatment has no significant effect on the progression rate of aortic valve sclerosis compared to no statin treatment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2018Open Access

Statins Have No Role in Preventing the Progression of Aortic Valve Sclerosis

Key Result

Statin treatment had no significant effect on the progression rate of aortic valve sclerosis compared to no statin treatment (0.012 vs. 0.014 m/s/yr, p = 0.956).

Study Design

Type

Cohort (n=541)

Multicenter

Structured PICO

Does statin therapy prevent the progression of aortic valve sclerosis in patients with AVS?

Population

541 consecutive patients with aortic valve sclerosis (AVS) defined as irregular thickening of the leaflets, focal increases in echogenicity and minimal elevation of the peak aortic valve velocity (> 1.5 and < 2 m/s), mean age 70, 40% male, from a single center in Korea. Exclusions included significant valvular diseases, left ventricular ejection fraction < 40%, congenital heart disease, cardiomyopathy, permanent pacemaker, uncontrolled tachycardia or bradycardia, and a history of cardiac surgery.

Intervention

Statin therapy prescribed during the study follow-up period (n=264).

Comparator

No statin therapy prescribed during the study follow-up period (n=277).

Outcome

Progression rate of AVS, expressed as the increase in peak aortic valve velocity per year (m/s/yr).surrogate

Statin therapy does not slow the echocardiographic progression of aortic valve sclerosis, extending prior evidence that statins are ineffective for preventing aortic stenosis progression.

Main Result

Absolute Event Rate: 0.012% vs 0.014%

p-value: p=0.956

Limitations

Retrospective study design with incomplete records of clinical and echocardiographic parameters
Did not grade aortic valve calcification based on echocardiography
Could not analyze the data according to the type and dose of statin due to the small sample size
Participants were limited to a single center and a single ethnicity

Abstract

BACKGROUND: Statins are thought to have little effect on the progression of aortic stenosis, but the data on their role in patients with aortic valve sclerosis (AVS) are limited and inconsistent. METHODS: We retrospectively analyzed 541 consecutive patients (214 men, age: 70 ± 11 years) with AVS. Each patient underwent two or more electrocardiography examinations at least 6 months apart at Kangwon National University Hospital from August 2010 to August 2015. AVS is defined as irregular thickening of the leaflets, focal increases in echogenicity and minimal elevation of the peak aortic valve velocity (> 1.5 and < 2 m/s). The progression rate of AVS was expressed as the increase in peak velocity per year (m/s/yr). RESULTS: The mean follow-up duration was 24.9 ± 13.3 months in the statin-treated group and 24.1 ± 12.4 months in the non-statin-treated group (p = 0.460). There were no differences between the statin-treated and non-statin-treated groups in mean age, gender or smoking status. Relative to the non-statin-treated group, a higher number of patients in the statin-treated group had hypertension, diabetes, ischemic heart disease, and stroke. The progression rate of AVS did not differ between the statin-treated and non-statin-treated groups (0.012 ± 0.340 m/s/yr vs. 0.014 ± 0.245 m/s/yr, p = 0.956). Multivariate analysis showed initial peak aortic jet velocity was significantly associated with AVS progression (β = 0.153, p = 0.009). CONCLUSIONS: Our study demonstrated that statins had no effect on the progression of AVS. However, well-designed studies are needed to define the prognosis and management of AVS.

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