Aortic stenosis and lipids: does intervention work?
OBJECTIVE
Aortic stenosis is a common disorder affecting increasing numbers of elderly patients, which is associated with markedly increased cardiovascular morbidity and mortality. Both histological and epidemiological studies have suggested that the process of valve degeneration may resemble atherosclerosis. This review investigates the potential role of lipid-lowering therapy in its management.


RESULTS
The current treatment methods are surgical or endovascular intervention but it has been hoped that antiatherosclerotic therapies might result in a reduction in progression and need for intervention. There have been a number of retrospective studies of lipid-lowering therapy, which suggested that statins might be effective in reducing progression of aortic stenosis. Lately a series of trials of aggressive statin therapy on surrogate markers of progression have shown no benefit from these measures. The controversial Simvastatin-Ezetimibe and Aortic Stenosis (SEAS) endpoint trial did not show any benefit on a combined endpoint of valve-related and ischaemic events but hinted at a reduction in cardiovascular events in this high cardiovascular risk group.


CONCLUSIONS
The data clearly shows statins have little effect in well established stenotic disease with calcification, but their effects earlier in the disease process (aortic valve sclerosis) remain to be determined.
Wierzbicki
Anthony S
AS
Guy's & St Thomas' Hospitals, UK. Anthony.Wierzbicki@kcl.ac.uk
Viljoen
Adie
A
Chambers
John B
JB
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001024:Aortic Valve Stenosis / Q000188:drug therapy* / Q000473:pathology; D001384:Azetidines / Q000627:therapeutic use; D054316:Biomarkers, Pharmacological; D002114:Calcinosis / Q000188:drug therapy; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000187:drug effects; D000069438:Ezetimibe; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy; D019821:Simvastatin / Q000627:therapeutic use; D013312:Stress, Physiological
D000924:Anticholesteremic Agents; D001384:Azetidines; D054316:Biomarkers, Pharmacological; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe