title: Impact of high-dose atorvastatin therapy and clinical risk factors on incident aortic valve stenosis in patients with cardiovascular disease (from TNT, IDEAL, and SPARCL).
abstract: Clinical trials have not provided evidence for a role of statin therapy in reducing aortic valve stenosis (AVS) severity in patients with documented AVS. However, whether statin therapy could prevent the onset of AVS is unknown. Our objectives were (1) to compare the incidence rates of AVS among patients treated with high-dose versus usual-dose statin or placebo and (2) to identify clinical risk factors associated with the development of AVS. We conducted post hoc analyses in 23,508 participants from 3 large-scale multicenter atorvastatin randomized blinded clinical trials: Treating to New Targets, the Incremental Decrease in End Points Through Aggressive Lipid Lowering, and the Stroke Prevention by Aggressive Reduction in Cholesterol Levels. The main outcome measure was the incidence of clinical AVS over a median follow-up of 4.9 years (82 cases). Among patients who developed AVS, 39 (47.6%) were treated with atorvastatin 80 mg and 43 (52.4%) were treated with lower dose statin (atorvastatin 10 mg in Treating to New Targets, simvastatin 20 to 40 mg in Incremental Decrease in End Points Through Aggressive Lipid Lowering, or placebo in Stroke Prevention by Aggressive Reduction in Cholesterol Levels; hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.59 to 1.41, p=0.67). In multivariate analyses forcing treatment, sex, and race into the model, factors that were significantly associated with AVS included age (HR 2.17, 95% CI 1.61 to 2.93, p<0.0001 per 1-SD increment), diabetes (HR 1.67, 95% CI 1.00 to 2.80, p=0.05), vitamin K antagonist use (HR 3.25, 95% CI 2.06 to 5.16, p<0.0001), and previous statin use (HR 2.65, 95% CI 1.54 to 4.60, p=0.0008). In conclusion, random allocation to high-dose versus usual-dose statin therapy or placebo did not impact the incidence of AVS among patients without known AVS. Age, diabetes, vitamin K antagonists, and previous statin use were significant predictors of incident AVS in these high-risk patients.
authors.affiliation: Montreal Heart Institute Research Center, Université de Montréal, Montreal, Canada.
authors.forename: Benoit J
authors.initials: BJ
authors.lastname: Arsenault
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Samia
authors.initials: S
authors.lastname: Mora
authors.affiliation: Pfizer Inc, New York, New York.
authors.forename: David A
authors.initials: DA
authors.lastname: DeMicco
authors.affiliation: Pfizer Inc, New York, New York.
authors.forename: Weihang
authors.initials: W
authors.lastname: Bao
authors.affiliation: Montreal Heart Institute Research Center, Université de Montréal, Montreal, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.affiliation: Department of Biostatistics, Epidemiology and Health Economics, Oslo University Hospital, Ulleval, Oslo, Norway.
authors.forename: Terje
authors.initials: T
authors.lastname: Pedersen
authors.affiliation: Centre for Vascular Biology, University of New South Wales, Sydney, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Barter
authors.affiliation: San Francisco General Hospital, San Francisco, California. Electronic address: dwaters@medsfgh.ucsf.edu.
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000008:administration & dosage; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000069059:Atorvastatin; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011758:Pyrroles / Q000008:administration & dosage*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D002784:Cholesterol; D000069059:Atorvastatin