Moura Luis M, Ramos Sandra F, Zamorano José L, Barros Isabel M, Azevedo Luis F, Rocha-Gonçalves Francisco, Rajamannan Nalini M
Hospital Pedro Hispano, Matosinhos, Portugal.
J Am Coll Cardiol. 2007 Feb 6;49(5):554-61. doi: 10.1016/j.jacc.2006.07.072. Epub 2007 Jan 22.
The objective of this study was to test the effect of a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor on the progression of moderate to severe aortic stenosis as measured by echocardiography.
Recent retrospective studies support the hypothesis that statins slow the progression of aortic stenosis.
We performed an open-label, prospective study evaluating 121 consecutive patients with asymptomatic moderate to severe aortic stenosis (aortic valve area > or = 1.0 cm2; mean age 73.7 +/- 8.9 years; 57 men and 64 women), treated with and without rosuvastatin according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Echocardiographic, serum lipid, and inflammatory markers were measured at baseline and every 6 months for 18 months.
Sixty-one patients (50.4%) with elevated LDL (159.7 +/- 33.4 mg/dl), aortic valve velocity (3.65 +/- 0.64 m/s), and aortic valve area (1.23 +/- 0.42 cm2) received rosuvastatin (20 mg/day), and 60 (49.6%) with a normal LDL (118.6 +/- 37.4 mg/dl), aortic valve velocity (3.62 +/- 0.61 m/s), and aortic valve area (1.20 +/- 0.35 cm2) received no statin. During a mean follow-up of 73 +/- 24 weeks, the change in aortic valve area in the control group was -0.10 +/- 0.09 cm2/year versus -0.05 +/- 0.12 cm2/year in the rosuvastatin group (p = 0.041). The increase in aortic valve velocity was 0.24 +/- 0.30 m/s/year in the control group and 0.04 +/- 0.38 m/s/year in the rosuvastatin group (p = 0.007). There was significant improvement in serum lipid and echocardiographic measures of aortic stenosis in the statin group.
Prospective treatment of aortic stenosis with rosuvastatin by targeting serum LDL slowed the hemodynamic progression of aortic stenosis. This is the first prospective study that shows a positive effect of statin therapy for this disease process. (Rosuvastatin Affecting Aortic Valve Endothelium; http://www.clinicaltrials.gov/ct/show/NCT00114491?order = 1; NCT0014491).
本研究的目的是通过超声心动图检测，测试3-羟基-3-甲基戊二酰辅酶A（HMG CoA）还原酶抑制剂对中重度主动脉瓣狭窄进展的影响。
近期的回顾性研究支持他汀类药物可减缓主动脉瓣狭窄进展这一假说。
我们开展了一项开放标签的前瞻性研究，评估121例连续入选的无症状中重度主动脉瓣狭窄患者（主动脉瓣面积≥1.0 cm²；平均年龄73.7±8.9岁；男性57例，女性64例），根据美国国家胆固醇教育计划成人治疗小组III指南，部分患者接受瑞舒伐他汀治疗，部分未接受。在基线及之后的18个月内，每6个月测量一次超声心动图、血脂及炎症指标。
61例（50.4%）低密度脂蛋白升高（159.7±33.4 mg/dl）、主动脉瓣流速（3.65±0.64 m/s）及主动脉瓣面积（1.23±0.42 cm²）的患者接受瑞舒伐他汀（20 mg/天）治疗，60例（49.6%）低密度脂蛋白正常（118.6±37.4 mg/dl）、主动脉瓣流速（3.62±0.61 m/s）及主动脉瓣面积（1.20±0.35 cm²）的患者未接受他汀类药物治疗。在平均73±24周的随访期内，对照组主动脉瓣面积的变化为-0.10±0.09 cm²/年，而瑞舒伐他汀组为-0.05±0.12 cm²/年（p = 0.041）。对照组主动脉瓣流速的增加为0.24±0.30 m/s/年，瑞舒伐他汀组为0.04±0.38 m/s/年（p = 0.007）。他汀类药物组的血脂及主动脉瓣狭窄的超声心动图指标有显著改善。
通过靶向血清低密度脂蛋白，采用瑞舒伐他汀对主动脉瓣狭窄进行前瞻性治疗可减缓主动脉瓣狭窄的血流动力学进展。这是第一项显示他汀类药物治疗对该疾病进程有积极作用的前瞻性研究。（瑞舒伐他汀对主动脉瓣内皮的影响；http://www.clinicaltrials.gov/ct/show/NCT00114491?order = 1；NCT0014491）
