Angiotensin-converting enzyme inhibitors and change in aortic valve calcium.
BACKGROUND
Calcium accumulation in the aortic valve is a hallmark of aortic sclerosis and aortic stenosis. Because lipoproteins, angiotensin-converting enzyme, and angiotensin II colocalize with calcium in aortic valve lesions, we hypothesized an association between angiotensin-converting enzyme inhibitor (ACEI) use and lowered aortic valve calcium (AVC) accumulation, as measured by electron beam computed tomography.


METHODS
Rates of change in volumetric AVC scores were determined retrospectively for 123 patients who had undergone 2 serial electron beam computed tomographic scans. The mean (+/-SD) interscan interval was 2.5 (+/-1.7) years; 80 patients did not receive ACEIs and 43 received ACEIs. The relationship of ACEI use to median rates of AVC score change (both unadjusted and adjusted for baseline AVC scores and coronary heart disease risk factors) was determined. We also examined the relationship of ACEI use to the likelihood of and adjusted odds ratio for definite progression (AVC change >2 times the median interscan variability).


RESULTS
Unadjusted and adjusted median rates of AVC score change were significantly higher in the no-ACEI group than in the ACEI group (adjusted median AVC changes [95% confidence interval]: relative, 28.7%/y [18.9%-38.5%/y] vs 11.0%/y [-1.9% to 24.0%/y], P = .04; absolute: 25.1/y [19.7-30.5/y] vs 12.2/y [4.5-19.9/y], P = .02). The adjusted odds ratio (95% confidence interval) for definite AVC progression was significantly lower for patients who received ACEIs (0.29 [0.11-0.75], P = .01).


CONCLUSIONS
This retrospective study finds a significant association between ACEI use and a lower rate of AVC accumulation. The results support the need for prospective, randomized trials of ACEIs in calcific aortic valve disease.
O'Brien
Kevin D
KD
Division of Cardiology, Box 356422, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA. cardiac@u.washington.edu
Probstfield
Jeffrey L
JL
Caulfield
Michael T
MT
Nasir
Khurram
K
Takasu
Junichiro
J
Shavelle
David M
DM
Wu
Audrey H
AH
Zhao
Xue-Qiao
XQ
Budoff
Matthew J
MJ
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000378:metabolism*; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000517:prevention & control*; D002118:Calcium / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D000806:Angiotensin-Converting Enzyme Inhibitors; D002118:Calcium