Association between calcific aortic stenosis and hypercholesterolemia: is there a need for a randomized controlled trial of cholesterol-lowering therapy?
BACKGROUND
Calcific aortic stenosis may have common etiological factors with atherosclerosis.


OBJECTIVE
In this retrospective, case-control study, we aimed to determine whether there is an association between hypercholesterolemia and calcific aortic valve stenosis.


METHODS
Consecutive patients undergoing single aortic or mitral valve replacement in a regional cardiothoracic surgical center were reviewed and preoperative patient characteristics were recorded: demographics, comorbidity (including coronary artery disease and associated risk factors), serum total cholesterol, lipid-lowering therapy, and serum creatinine.


RESULTS
Serum total cholesterol concentrations were significantly higher in patients with calcific aortic stenosis than in controls (6.2+/-1.1 vs. 5.3+/-1.1 mmol/l; p < 0.001). The significant difference in serum cholesterol concentrations remained following correction for gender and body mass index (p = 0.02) and when patients with coronary artery disease were excluded (6.3+/-1.1 vs. 5.3+/-1.4 mmol/l; p<0.001). Subgroup analysis demonstrated that the association between elevated serum cholesterol concentrations and calcific aortic stenosis was particularly strong in patients with tricuspid aortic valves (6.4+/-1.2 vs. 5.3+/-1.1 mmol/l; p < 0.001) compared with those with bicuspid valves (5.9+/-1.1 vs. 5.3+/-1.1 mmol/l; p = 0.06).


CONCLUSIONS
We conclude that hypercholesterolemia is associated with calcific aortic stenosis and may be implicated in its pathogenesis and progression. We believe that there is now a need for a randomized, controlled trial of cholesterol-lowering therapy in patients with calcific aortic stenosis.
Chui
M C
MC
Department of Cardiology, Royal Infirmary, Edinburgh, Scotland, UK.
Newby
D E
DE
Panarelli
M
M
Bloomfield
P
P
Boon
N A
NA
D000368:Aged; D000924:Anticholesteremic Agents; D001024:Aortic Valve Stenosis / Q000097:blood / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D002114:Calcinosis / Q000097:blood / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000175:diagnosis; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors
D000924:Anticholesteremic Agents; D002784:Cholesterol