title: Lipid lowering on progression of mild to moderate aortic stenosis: meta-analysis of the randomized placebo-controlled clinical trials on 2344 patients.
abstract: BACKGROUND
  Aortic stenosis (AS) is believed to develop through an inflammatory similar to the atherosclerosis process. Based on findings from animal studies and uncontrolled clinical studies, lipid-lowering therapy with a statin is postulated to slow this process. Randomized trials, however, reported neutral results. This meta-analysis of randomized lipid trials on patients with AS examined the effects of treatment on AS progression and clinical outcomes.
  
  
  METHODS
  Echocardiographic measures of AS (aortic valve jet velocity, peak and mean valve gradients, and aortic valve area) were pooled and clinical outcomes were evaluated in 4 randomized placebo controlled trials (N=2344).
  
  
  RESULTS
  Although active treatment with statin therapy was associated with highly significant 50% reduction in low-density lipoprotein cholesterol levels, there were no statistical differences between active and placebo groups in any of the echocardiographic indicators of AS severity: annual increase in AS velocity was 0.16±0.28 m/sec, and mean gradient was 2.8±3.0 mm Hg. Each trial reported no differences in clinical outcomes between the 2 treatment groups. Substantial events rates (6.6% aortic valve surgery and 1.2% cardiovascular deaths per year in SEAS with follow-up of 4.4 years and 5.8% aortic valve surgery and 0.7% cardiovascular deaths per year in ASTRONOMER over 3.5 years) were observed in these patients despite the relatively mild disease.
  
  
  CONCLUSIONS
  The current data do not support the hypothesis that statin therapy reduces AS progression. Patients with mild to moderate AS may require closer follow-up because despite the less severe disease in these trials, event rates remain substantial.
authors: Population Health Research Institute, McMaster University, and Hamilton General Hospital, Hamilton, Ontario, Canada. teok@mcmaster.ca
authors: Koon K
authors: KK
authors: Teo
authors: Daniel J
authors: DJ
authors: Corsi
authors: James W
authors: JW
authors: Tam
authors: Jean G
authors: JG
authors: Dumesnil
authors: Kwan L
authors: KL
authors: Chan
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D004452:Echocardiography; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000960:Hypolipidemic Agents