Document Detail

The effect of angiotensin-converting enzyme inhibitors and statins on the progression of aortic sclerosis and mortality.
MedLine Citation:
PMID:  22808835     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: Although aortic sclerosis has been associated with an increase in adverse cardiovascular outcomes, no proven therapy has been shown to slow its progression to overt aortic stenosis (AS). Thus, the hypothesis was assessed that treatment with angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) or statins may be associated with an improvement in the clinical outcome of these patients.
METHODS: A total of 4,105 patients with evidence of aortic sclerosis seen on transthoracic echocardiography (defined as thickening or calcification with a mean valve gradient < or = 15 mmHg) was identified. Patients with a sclerotic valve who were treated with ACE-Is/ARBs or statins were followed for a mean period of 1,078 +/- 615 days. After adjustment for the propensity to receive ACE-Is/ARBs or statins, mortality, hemodynamic progression to AS, hospitalization for ischemic heart disease (IHD), and congestive heart failure (CHF) were assessed and related to the medical treatment.
RESULTS: At baseline, patients with aortic sclerosis who were treated with an ACE-I/ARB or a statin suffered significantly more from comorbidities such as IHD, CHF, hypertension, diabetes, and peripheral arterial disease, when compared to subjects with sclerotic valves not treated with these drugs. After adjustment for confounding factors, treatment with statins was associated with a significant reduction in mortality (odds ratio [OR] 0.73, 95% CI 0.56-0.98, p = 0.001), admission for IHD (OR 0.81, 95% CI 0.66-0.99, p = 0.03), admission for CHF (OR 0.68, 95% CI 0.55-0.85, p = 0.01) and progression to AS (OR 0.64, 95% CI 0.42-0.97, p = 0.03). While ACE-I treatment resulted in a significant reduction in admission for IHD (OR 0.80, 95% CI 0.65-0.98, p = 0.03) and CHF (OR 0.76, 95% CI 0.62-0.94, p = 0.01), the beneficial trend towards reduced mortality and delayed progression to AS was not significant.
CONCLUSION: Treatment of this patient population with statins led to a significant reduction in mortality and also slowed the progression to AS--an effect that was not statistically significant with ACE-I treatment.
Reza Ardehali; Nicholas J Leeper; Andrew M Wilson; Paul A Heidenreich
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  21     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-07-19     Completed Date:  2012-09-12     Revised Date:  2014-10-15    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  337-43     Citation Subset:  IM    
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MeSH Terms
Angiotensin Receptor Antagonists / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Aortic Diseases* / complications,  drug therapy,  mortality,  physiopathology
Aortic Valve Stenosis / etiology,  physiopathology,  prevention & control*
Atherosclerosis* / complications,  drug therapy,  mortality,  physiopathology
Chronic Disease
Disease Progression
Echocardiography / methods
Hemodynamics / drug effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Quality-Adjusted Life Years
Secondary Prevention / methods
Severity of Illness Index
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Angiotensin Receptor Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors

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