Statins fail to halt calcific aortic stenosis progression
MedWire News: Statins do not improve clinical outcomes or reduce disease progression in non-rheumatic calcific aortic valve stenosis, results of a meta-analysis suggest.
"Although statins have well-established effects on major endpoints in several patient populations, both in primary and secondary prevention, they do not have the same effect on major endpoints in patients with calcific aortic stenosis," say Alessandro Parolari (University of Milan, Italy) and team.
They suggest that statin therapy, as an effective preventive strategy, should be assessed very early in patients at risk of calcific aortic valve disease, and no later than at the first diagnosis of aortic sclerosis or mild stenosis.
The researchers analyzed ten studies providing data on 2214 non statin-treated and 1608 statin-treated patients affected by calcific non-rheumatic aortic stenosis. Five of the studies were prospective and five retrospective, while three were randomized and seven were not randomized.
Overall, the team found no significant differences in all-cause mortality, cardiovascular mortality, or the need for aortic valve surgery between statin treated and untreated patients.
In the lower quality (retrospective or non-randomized) studies, annual increases in peak aortic jet velocity and annual decreases in aortic valve area were lower in statin-treated patients compared with untreated patients. However this was not confirmed by the analysis in high-quality (prospective or randomized) studies.
Although the overall effect of statin treatment on the mean annual difference of jet velocity progression and aortic valve area were reduced by 0.08 m/s and 0.02 cm2 per year, respectively, the researchers found that this was driven by results from lower quality studies.
Furthermore, the progression over time of peak and mean aortic gradient was slightly lower in statin-treated patients compared with untreated patients, but these results were not statistically significant.
Writing in the journal Heart, Parolari et al comment: "Our study does not support the concept that statins may reduce the progression rate of calcific non-rheumatic aortic stenosis."
They conclude that their findings indicate the need for adequately powered, well-designed, prospective randomized controlled studies in patients at earlier stages of the disease.
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By Nikki Withers