Antonini-Canterin Francesco, Leiballi Elisa, Enache Roxana, Popescu Bogdan A, Roşca Monica, Cervesato Eugenio, Piazza Rita, Ginghină Carmen, Nicolosi Gian Luigi
Cardiologia ARC, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy.
J Am Coll Cardiol. 2009 May 19;53(20):1874-9. doi: 10.1016/j.jacc.2009.01.064.
This study sought to assess the effect of hydroxymethylglutaryl coenzyme-A reductase inhibitors (statins) on the progression of rheumatic aortic valve stenosis.
The possible role of statins in slowing the progression of degenerative aortic valve stenosis (AS) is still debated. No information about the role of statin treatment in patients with rheumatic AS is available yet.
From our 1988 to 2008 echocardiographic database, we retrospectively identified all patients with rheumatic AS, with a baseline peak aortic velocity >or=1.5 m/s and at least 2 echocardiographic studies >or=2 years apart. Exclusion criteria were: severe aortic regurgitation, bicuspid aortic valve, and left ventricular ejection fraction <40%.
The study population consisted of 164 patients (30 treated with statins) followed up for 8.5 +/- 4.2 years. Peak aortic velocity at baseline was not different in patients treated with statins versus untreated patients (2.3 +/- 0.8 m/s vs. 2.3 +/- 0.7 m/s, p = 0.84). There were no significant differences in sex, age, or follow-up duration between the 2 groups. Progression of AS severity was slower in patients receiving statins compared with untreated patients (annual change of peak aortic velocity: 0.05 +/- 0.07 m/s/year vs. 0.12 +/- 0.11 m/s/year, p = 0.001). An annual rate of peak velocity progression >or=0.1 m/s was found in 10% of statin-treated patients and in 49% of untreated patients (p < 0.0001).
This is the first observation of a positive effect of statin treatment in reducing the progression of rheumatic AS. The underlying mechanisms remain to be clarified.
本研究旨在评估羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）对风湿性主动脉瓣狭窄进展的影响。
他汀类药物在减缓退行性主动脉瓣狭窄（AS）进展中可能发挥的作用仍存在争议。目前尚无关于他汀类药物治疗风湿性AS患者作用的相关信息。
从我们1988年至2008年的超声心动图数据库中，我们回顾性识别了所有风湿性AS患者，其基线主动脉峰值流速≥1.5米/秒，且至少有2次间隔≥2年的超声心动图检查。排除标准为：严重主动脉瓣反流、二叶式主动脉瓣以及左心室射血分数<40%。
研究人群包括164例患者（30例接受他汀类药物治疗），随访时间为8.5±4.2年。接受他汀类药物治疗的患者与未接受治疗的患者基线时的主动脉峰值流速无差异（2.3±0.8米/秒对2.3±0.7米/秒，p = 0.84）。两组在性别、年龄或随访时间方面无显著差异。与未接受治疗的患者相比，接受他汀类药物治疗的患者AS严重程度进展较慢（主动脉峰值流速的年变化：0.05±0.07米/秒/年对0.12±0.11米/秒/年，p = 0.001）。在接受他汀类药物治疗的患者中，10%的患者峰值流速年进展率≥0.1米/秒，而在未接受治疗的患者中这一比例为49%（p < 0.0001）。
这是首次观察到他汀类药物治疗对减缓风湿性AS进展具有积极作用。其潜在机制仍有待阐明。
