title: Do bisphosphonates slow the progression of aortic stenosis?
abstract: OBJECTIVE
  The aim of this study was to investigate the impact of bisphosphonates on the progression of aortic stenosis.
  
  
  BACKGROUND
  Valvular calcification is associated with the development and progression of aortic stenosis. Bisphosphonates have been suggested to slow this progression.
  
  
  METHODS
  Female patients older than the age of 60 years with an aortic valve area (AVA) between 1.0 and 2.0 cm(2) were identified and studied retrospectively. Only those who had follow-up echocardiograms at least a year apart were included. Primary outcomes were the change in AVA and valvular gradients over time. Mortality and freedom from aortic valve replacement were also studied. A propensity-matching method was applied for the probability of the use of bisphosphonates.
  
  
  RESULTS
  The study included 801 female patients (mean age, 76 ± 7.6 years) with a mean follow-up of 5.1 ± 2.4 years. The mean duration of bisphosphonate use was 3.1 ± 2.6 years. At the time of the initial echocardiogram, 323 patients (38%) were taking bisphosphonates. The mean ejection fraction at baseline was 56.7 ± 9.6% with a mean AVA of 1.32 ± 0.25 cm(2). Peak and mean gradients were 28.4 ± 11 mm Hg and 15.6 ± 6.8 mm Hg, respectively. Propensity matching was successfully performed for 438 patients. On follow-up, there were no differences in the rate of change in AVA or peak and mean gradients when patients were stratified based on the use of bisphosphonates. Bisphosphonates also had no impact on survival or freedom from aortic valve replacement.
  
  
  CONCLUSIONS
  In this retrospective analysis of older female patients, bisphosphonates do not have a significant impact on the hemodynamic or clinical progression of aortic stenosis.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Ohio 44195, USA.
authors.forename: Olcay
authors.initials: O
authors.lastname: Aksoy
authors.forename: Akin
authors.initials: A
authors.lastname: Cam
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Goel
authors.forename: Penny L
authors.initials: PL
authors.lastname: Houghtaling
authors.forename: Sarah
authors.initials: S
authors.lastname: Williams
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ruiz-Rodriguez
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
mesh_terms: D000368:Aged; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates