Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis

Abstract

Objectives: The objective of this study was to test the effect of a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor on the progression of moderate to severe aortic stenosis as measured by echocardiography.

Background: Recent retrospective studies support the hypothesis that statins slow the progression of aortic stenosis.

Methods: We performed an open-label, prospective study evaluating 121 consecutive patients with asymptomatic moderate to severe aortic stenosis (aortic valve area > or = 1.0 cm2; mean age 73.7 +/- 8.9 years; 57 men and 64 women), treated with and without rosuvastatin according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Echocardiographic, serum lipid, and inflammatory markers were measured at baseline and every 6 months for 18 months.

Results: Sixty-one patients (50.4%) with elevated LDL (159.7 +/- 33.4 mg/dl), aortic valve velocity (3.65 +/- 0.64 m/s), and aortic valve area (1.23 +/- 0.42 cm2) received rosuvastatin (20 mg/day), and 60 (49.6%) with a normal LDL (118.6 +/- 37.4 mg/dl), aortic valve velocity (3.62 +/- 0.61 m/s), and aortic valve area (1.20 +/- 0.35 cm2) received no statin. During a mean follow-up of 73 +/- 24 weeks, the change in aortic valve area in the control group was -0.10 +/- 0.09 cm2/year versus -0.05 +/- 0.12 cm2/year in the rosuvastatin group (p = 0.041). The increase in aortic valve velocity was 0.24 +/- 0.30 m/s/year in the control group and 0.04 +/- 0.38 m/s/year in the rosuvastatin group (p = 0.007). There was significant improvement in serum lipid and echocardiographic measures of aortic stenosis in the statin group.

Conclusions: Prospective treatment of aortic stenosis with rosuvastatin by targeting serum LDL slowed the hemodynamic progression of aortic stenosis. This is the first prospective study that shows a positive effect of statin therapy for this disease process. (Rosuvastatin Affecting Aortic Valve Endothelium; http://www.clinicaltrials.gov/ct/show/NCT00114491?order = 1; NCT0014491).

Figure 1. Patient Flow Diagram

Flow chart of patient enrollment. pts = patients.

Figure 2. Progression of Aortic Valve Stenosis in Patients Treated With Rosuvastatin Therapy and Untreated Patients

(A) Aortic jet velocity in treated versus untreated patients. (B) Aortic mean gradient in treated versus untreated patients. (C) Aortic valve area in treated versus untreated patients.

Figure 3. Correlation of LDL Cholesterol With Echocardiographic Hemodynamic Measurements in Treated Patients

(A) Aortic jet velocity in treated patients. (B) Aortic mean gradient in treated patients. (C) Aortic valve area in treated patients. LDL = low-density lipoprotein.