Angiotensin II Receptor Blockers Are Associated With Reduced Valvular Fibrosis in Women With Aortic Stenosis

Area of Science:

• Cardiology
• Pharmacology
• Fibrosis Research

Background:

• Angiotensin receptor blockers (ARBs) possess antifibrotic properties that may impede aortic stenosis (AS) progression.
• Women exhibit greater valvular fibrosis in AS compared to men, suggesting a potentially enhanced effect of ARBs in females.
• This study aimed to investigate the differential impact of ARBs on aortic valve remodeling in men and women.

Purpose of the Study:

• To assess the impact of Angiotensin receptor blockers (ARBs) on aortic valve remodeling.
• To determine if the antifibrotic effects of ARBs are sex-specific in patients with aortic stenosis (AS).

Main Methods:

• Analysis of 1321 patients undergoing aortic valve replacement between 2006 and 2013.
• Exclusion of patients with incomplete echocardiographic or histologic data.
• Classification of valves into four phenotypes based on Warren-Yong and fibrosis scores: mild calcification/fibrosis, severe calcification/fibrosis, predominant fibrosis, and predominant calcification.

Main Results:

• Patients in the predominant fibrosis group were more frequently female and had bicuspid valves, with less frequent ARB use compared to the predominant calcification group.
• Female sex was independently associated with the predominant fibrosis phenotype, with a significant interaction observed between female sex and ARB use.
• Women taking ARBs demonstrated significantly lower valvular fibrosis scores compared to women not taking ARBs; this effect was not observed in men.

Conclusions:

• In patients with moderate-to-severe aortic stenosis (AS), a negative association exists between Angiotensin receptor blockers (ARBs) use and valvular fibrosis in women.
• The antifibrotic effects of ARBs appear to be sex-specific, indicating a potentially larger therapeutic role for ARBs in women with AS.
• Further research into sex-specific mechanisms and treatments for AS is warranted.