Gilmanov Daniyar, Bevilacqua Stefano, Mazzone Annamaria, Glauber Mattia
Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy.
Interact Cardiovasc Thorac Surg. 2010 Sep;11(3):297-301. doi: 10.1510/icvts.2009.230920. Epub 2010 Jun 22.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether statins slow the process of calcification of aortic tissue valves. Altogether 207 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We acknowledge the limited evidence in this very specific field of cardiac surgery. Due to their pleiotropic effects, including anti-inflammatory properties, there has been speculation that statins could reduce and delay the degeneration and calcification of aortic bioprosthetic valves. Mainly, it was extrapolation of the recently discovered molecular similarities between atherosclerosis and native aortic valve stenosis (AS), with some evidence that statins may slow the progression of native aortic valve calcific degeneration, and the potential harmful impact of atherosclerotic risk factors on the development of native AS. Several studies have been conducted to evaluate the impact of hyperlipidemia and serum cholesterol levels on structural valve deterioration (SVD). Indeed, two studies suggested hyperlipidemia was a risk factor for SVD and correlated reoperation, from which one case-control study based on first-generation biological valves without specific anti-calcification treatment, while three - more convincing by number of patients observed and design of the study - reported contrary results. The other three studies focused on statin treatment in patients after aortic biological valve replacement. Two studies confirmed beneficial effects of statin therapy on valve hemodynamics or inflammatory damage in vivo, but another study, with significantly greater patients series, found lipid-lowering therapy futile in this clinical aspect. Currently, studies and their results are discordant, but statin therapy appears insufficient to result in better clinical outcomes. We conclude that even though the data is conflicting, statin therapy does not prevent SVD of bioprosthetic valves in the aortic position.
一篇心脏外科领域的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是他汀类药物是否能减缓主动脉组织瓣膜的钙化进程。通过报告的检索共找到207篇论文，其中8篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期、国家、研究的患者群体、研究类型、相关结局和结果均列于表格中。我们承认在心脏外科这个非常特定的领域证据有限。由于他汀类药物具有多效性作用，包括抗炎特性，有人推测他汀类药物可能会减少并延缓主动脉生物瓣膜的退变和钙化。主要是基于最近发现的动脉粥样硬化与天然主动脉瓣狭窄（AS）之间的分子相似性进行推断，有一些证据表明他汀类药物可能会减缓天然主动脉瓣钙化退变的进程，以及动脉粥样硬化危险因素对天然AS发展的潜在有害影响。已经进行了多项研究来评估高脂血症和血清胆固醇水平对瓣膜结构退变（SVD）的影响。确实，两项研究表明高脂血症是SVD和再次手术的危险因素，其中一项病例对照研究基于未进行特定抗钙化治疗的第一代生物瓣膜，而另外三项研究——从观察到的患者数量和研究设计来看更具说服力——报告了相反的结果。另外三项研究聚焦于主动脉生物瓣膜置换术后患者的他汀类药物治疗。两项研究证实了他汀类药物治疗对体内瓣膜血流动力学或炎症损伤的有益作用，但另一项研究，其患者系列数量显著更多，发现在这一临床方面降脂治疗无效。目前，各项研究及其结果不一致，但他汀类药物治疗似乎不足以带来更好的临床结局。我们得出结论，尽管数据相互矛盾，但他汀类药物治疗并不能预防主动脉位置生物瓣膜的SVD。
