[Statins in aortic stenosis]

Patients with any degree of aortic-valve disease have increased cardiovascular morbidity and mortality. The active inflammatory component of calcific aortic valve disease has been recognized, and similarities with atherosclerotic disease have been identified. Both calcific aortic valve disease and atherosclerosis are characterized by lipid infiltration, inflammation, neoangiogenesis, calcification, and endothelial dysfunction. From these observations, the hypothesis has emerged that statins, which reduce the progression of atherosclerotic disease and significantly improve the clinical outcome in patients with coronary artery disease, might also be beneficial in patients with aortic stenosis. Since aortic stenosis, like atherosclerosis, is an active disease process, it seems plausible that statins might slow its hemodynamic progression. In addition, the use of statins might also lead to a reduction in cardiovascular end points in the group of patients at high risk for vascular complications. Evidence that lipid lowering therapy slowed the progression of aortic stenosis relative to non statin therapy was suggested by several retrospective studies but some prospective studies, such as SALTIRE trial, found that intensive lipid lowering therapy did not halt the progression of calcific aortic stenosis. So, we can not recommend statin therapy for patients with calcific aortic stenosis in the absence of coexisting coronary disease.