Rajamannan Nalini M, Antonini-Canterin Francesco, Moura Luis, Zamorano Jose L, Rosenhek Raphael A, Best Patricia Jm, Lloyd Margaret A, Rocha-Goncalves F, Chandra Sarat, Alfieri Ottavio, Lancellotti Patrizio, Tornos Pilar, Baliga Ragavendra R, Wang Andrew, Bashore Thomas, Ramakrishnan S, Spargias Konstantinos, Shuvy Mony, Beeri Ronen, Lotan Chaim, Suwaidi Jassim Al, Bahl Vinay, Pierard Luc A, Maurer Gerald, Nicolosi Gian Luigi, Rahimtoola Shahbudin H, Chopra K, Pandian Natesa G
Bluhm Cardiovascular Institute, Nortwestern University Feinberg School of Medicine, Tarry, Chicago IL, USA.
Indian Heart J. 2009 Jan-Feb;61(1):14-23.
Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population.
风湿性心脏病（RHD）是一种众所周知的活动性炎症过程，随着时间的推移会逐渐发展为钙化和瓣叶增厚。他汀类药物治疗在减缓瓣膜性心脏病进展方面的潜力仍存在争议。回顾性研究表明，药物治疗对钙化性主动脉瓣狭窄患者有益，最近对风湿性瓣膜病患者也有益。然而，迄今为止前瞻性随机临床试验的结果均为阴性。本文讨论了瓣膜性心脏病的流行病学危险因素、基础科学、回顾性和前瞻性研究，以及一项针对RHD采用他汀类药物治疗以减缓该病进展的未来临床试验。最近的流行病学研究显示，与瓣膜病相关的危险因素包括男性、吸烟、高血压和血清胆固醇升高，这些与血管动脉粥样硬化的危险因素相似。越来越多的实验性高胆固醇血症模型显示主动脉瓣（AV）出现动脉粥样硬化特征，这与血管动脉粥样硬化病变的早期阶段相似。钙化是该疾病的终末期过程，必须在为时已晚之前将其理解为改变这种细胞过程的预后指标。这在钙化性主动脉瓣狭窄以及风湿性瓣膜病中都很重要。越来越多的研究表明，风湿性瓣膜病发展过程中的病理生理分子标志物与钙化性主动脉瓣狭窄相似。总之，这些发现表明，药物治疗可能在该疾病过程早期的患者中发挥潜在作用，以减缓影响瓣膜的RHD的进展。本综述将总结他汀类药物治疗该患者群体的潜力。
