title: Risk Factors for Progression of Degenerative Aortic Valve Disease in the Japanese- The Japanese Aortic Stenosis Study (JASS) Prospective Analysis.
abstract: BACKGROUND
  Because of ethnic difference in the risk of degenerative aortic valve disease (DAVD), risk factors should be clarified in each race to establish prophylactic strategies for severe aortic valve stenosis (AS).
  
  
  RESULTS
  This study prospectively followed 359 Japanese subjects with DAVD and age ≥50 years for 3 years. As both patients with peak aortic transvalvular flow velocity ≥2 m/s and <2 m/s were enrolled, subgroup analysis was also conducted. Most patients were under treatment for their comorbidities. The use of warfarin, but none of the traditional risk factors for atherosclerosis, was related to greater reduction in aortic valve area indexed to body surface area (iAVA). In patients with peak aortic transvalvular flow velocity <2 m/s, the use of an angiotensin-receptor blocker (ARB) was associated with less decrease in iAVA. In patients with peak velocity ≥2 m/s, changes in iAVA were not related to any baseline characteristics, but peak velocity was less increased under treatment with an angiotensin-converting enzyme inhibitor (ACEI).
  
  
  CONCLUSIONS
  In Japanese, the use of warfarin may exacerbate DAVD, and augmented management of atherosclerotic risk factors beyond the recommendations in the current guidelines is unlikely to exert additional benefit. The prescription of ARB for DAVD patients before the development of AS or ACEI after the development of AS may be useful.
authors.affiliation: Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Akira
authors.initials: A
authors.lastname: Kisanuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohte
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirano
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Sozu
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D044466:Asian People; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014859:Warfarin