title: Statin use for nonrheumatic calcific aortic valve stenosis: a review with meta-analysis.
abstract: OBJECTIVE
  To synthesize by meta-analysis the findings of recent experimental studies focusing on possible therapeutic effectiveness of statins for nonrheumatic calcific aortic stenosis.
  
  
  METHODS
  Observational studies and randomized controlled trials (RCTs) were selected from the Pubmed database to evaluate the hemodynamic progression of aortic stenosis in statin-treated patients compared with controls (i.e. patients with aortic stenosis taking placebo or no treatment). The endpoints were the annualized changes in one or more of the following ultrasonographic measurements: peak aortic valve jet velocity, peak aortic valve pressure gradient, mean aortic valve pressure gradient aortic valve area (AVA). For estimating the overall effect of statin therapy on each of the above-mentioned continuous variables across the considered studies, we used the weighted mean difference (WMD) as effect size measure. In addition, we calculated the odds of aortic valve replacement surgery and cardiovascular death in both statin-treated patients and controls for subsequently estimating the appropriate odds ratios.
  
  
  RESULTS
  Nine studies were selected. A lower annualized increase in peak aortic valve jet velocity was found in statin-treated patients compared with controls (overall WMD: -0.09 m/s per year, 95% CI -0.16, -0.01 P = 0.018). Similarly, a smaller annualized increase in peak aortic valve pressure gradient was found in the statin group (overall WMD: -2.04 mmHg/year 95% CI: -3.56, -0.52, P = 0.0085). However, the overall effects in statin-treated patients on both annualized increases in mean aortic valve pressure gradient and decreases in AVA were not significantly different from those found in controls. Moreover, there was no significant difference in cardiovascular outcomes in the statin groups compared with placebo groups in each of the three analyzed RCTs and overall.
  
  
  CONCLUSIONS
  Significant benefit of statin therapy in retarding hemodynamic deterioration was identified by favorable effects concerning annualized changes in peak aortic valve jet velocity and peak aortic valve pressure gradient; on the contrary, in statin-treated patients with aortic stenosis, no significant improvement was found for annualized changes in mean aortic valve pressure gradient and AVA and clinical outcomes.
authors.affiliation: Cardiology Unit, Presidio Sanitario Intermedio Elena d'Aosta, Napoli, Italy. r.de.vecchis@alice.it
authors.forename: Renato
authors.initials: R
authors.lastname: De Vecchis
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Di Biase
authors.forename: Claudia
authors.initials: C
authors.lastname: Esposito
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciccarelli
authors.forename: Carmela
authors.initials: C
authors.lastname: Cioppa
authors.forename: Anna
authors.initials: A
authors.lastname: Giasi
authors.forename: Carmelina
authors.initials: C
authors.lastname: Ariano
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cantatrione
mesh_terms: D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D002114:Calcinosis / Q000188:drug therapy*; D018450:Disease Progression; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors