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Do statins improve outcomes and delay the progression of non-rheumatic calcific aortic stenosis?
Alessandro Parolari1, Elena Tremoli, Laura Cavallotti
1Unit for Clinical Research in Atherothrombosis, Centro Cardiologico Monzino IRCCS; Department of Cardiovascular Sciences, University of Milan, Milan, Italy. alessandro.parolari@cardiologicomonzino.it
Insights
Statin treatment does not improve clinical outcomes or slow the progression of calcific aortic stenosis. Current evidence does not support its use for this condition.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- The efficacy of statin therapy in non-rheumatic calcific aortic stenosis is unknown.
- Clinical outcomes and disease progression in this patient group require further investigation.
Purpose of the Study:
- To conduct a meta-analysis of studies comparing statin therapy with placebo or no treatment.
- To evaluate the impact of statins on clinical outcomes and echocardiographic parameters of aortic stenosis progression.
Main Methods:
- A systematic literature search was performed up to January 2010.
- Data from 10 studies involving 3822 participants were meta-analyzed.
- Subanalyses were conducted on low-quality (retrospective/non-randomized) and high-quality (prospective/randomized) studies.
Main Results:
- No significant differences were observed in all-cause mortality, cardiovascular mortality, or the need for aortic valve surgery.
- Lower-quality studies suggested statins might reduce aortic jet velocity and increase aortic valve area, but this was not supported by high-quality studies.
- Statins did not significantly affect the progression of peak and mean aortic gradients.
Conclusions:
- Existing data do not support the use of statins for improving outcomes in calcific aortic stenosis.
- Statins do not appear to reduce disease progression in this condition based on current evidence.
Context:
It is not known whether statin treatment improves clinical outcomes and reduces aortic stenosis progression in non-rheumatic calcific aortic stenosis.
Objective:
A meta-analysis of studies was performed comparing statin therapy with placebo or no treatment on outcomes and on aortic stenosis progression echocardiographic parameters.
Data Sources:
The authors searched Medline and Pubmed up to January 2010.
Data Extraction:
Two independent reviewers independently abstracted information on study design (prospective vs retrospective or randomised vs non-randomised), study and participant characteristics. Fixed and random effects models were used. A-priori subanalyses assessed the effect of statins on low-quality (retrospective or non-randomised) and on high-quality (prospective or randomised) studies separately.
Results:
Meta-analysis identified 10 studies with a total of 3822 participants (2214 non-statin-treated and 1608 statin-treated); five studies were classified as prospective and five as retrospective; concerning randomisation, three trials were randomised whereas seven were not. No significant differences were found in all-cause mortality, cardiovascular mortality or in the need for aortic valve surgery. Lower-quality (retrospective or non-randomised) studies showed that, in statin-treated patients, the annual increase in peak aortic jet velocity and the annual decrease in aortic valve area were lower, but this was not confirmed by the analysis in high-quality (prospective or randomised) studies. Statins did not significantly affect the progression over time of peak and mean aortic gradient.
Conclusions:
Currently available data do not support the use of statins to improve outcomes and to reduce disease progression in non-rheumatic calcific aortic valve stenosis.
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