Statin therapy and aortic stenosis: a systematic review of the effects of statin therapy on aortic stenosis.

摘要

Aortic stenosis is a condition that is inflicting an increasing number of the elderly in North America and Europe. Current treatment for aortic stenosis is aortic valve replacement. An expanding pool of knowledge regarding the mechanism of aortic stenosis has led to the testing of statins to reduce the progression of aortic stenosis. Reviews, randomized, controlled trials and other studies pertaining to the topic were searched for using Medline, Cochrane Library, and ScienceDirect. Search terms used were "HMG-CoA reductase inhibitors" and "aortic stenosis." Studies found were then searched for relevant data and ranked using a rating system to determine the validity and quality of the study's results by evaluating the methodology used to include patients, clinical end points examined, and the methodology used to analyze data. Hand searches for referenced studies were also carried out. Studies with relevant results of acceptable quality were then incorporated. Statins have been found to be generally ineffective in delaying the progression of aortic stenosis, although some cohort studies found improvements in valve hemodynamics. Aortic stenosis lesions are characterized by calcific and lipoproteinacous deposits and end-stage aortic stenosis results in valve ossification. Although retrospective and prospective cohort studies show that statins do delay progression of aortic stenosis and improve hemodynamics of the affected valve, randomized, controlled study data do not reinforce these findings. Simvastatin and Ezetimibe in Aortic Stenosis (SEAS), a large randomized, controlled trial, not only found that statins have no significant effect on progression of aortic stenosis, but that statin therapy in those with aortic stenosis may lead to a higher incidence of cancer.