Ardehali Reza, Leeper Nicholas J, Wilson Andrew M, Heidenreich Paul A
Division of Cardiology, University of California Los Angeles, Los Angeles, CA 90095-1760, USA.
J Heart Valve Dis. 2012 May;21(3):337-43.
Although aortic sclerosis has been associated with an increase in adverse cardiovascular outcomes, no proven therapy has been shown to slow its progression to overt aortic stenosis (AS). Thus, the hypothesis was assessed that treatment with angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) or statins may be associated with an improvement in the clinical outcome of these patients.
A total of 4,105 patients with evidence of aortic sclerosis seen on transthoracic echocardiography (defined as thickening or calcification with a mean valve gradient < or = 15 mmHg) was identified. Patients with a sclerotic valve who were treated with ACE-Is/ARBs or statins were followed for a mean period of 1,078 +/- 615 days. After adjustment for the propensity to receive ACE-Is/ARBs or statins, mortality, hemodynamic progression to AS, hospitalization for ischemic heart disease (IHD), and congestive heart failure (CHF) were assessed and related to the medical treatment.
At baseline, patients with aortic sclerosis who were treated with an ACE-I/ARB or a statin suffered significantly more from comorbidities such as IHD, CHF, hypertension, diabetes, and peripheral arterial disease, when compared to subjects with sclerotic valves not treated with these drugs. After adjustment for confounding factors, treatment with statins was associated with a significant reduction in mortality (odds ratio [OR] 0.73, 95% CI 0.56-0.98, p = 0.001), admission for IHD (OR 0.81, 95% CI 0.66-0.99, p = 0.03), admission for CHF (OR 0.68, 95% CI 0.55-0.85, p = 0.01) and progression to AS (OR 0.64, 95% CI 0.42-0.97, p = 0.03). While ACE-I treatment resulted in a significant reduction in admission for IHD (OR 0.80, 95% CI 0.65-0.98, p = 0.03) and CHF (OR 0.76, 95% CI 0.62-0.94, p = 0.01), the beneficial trend towards reduced mortality and delayed progression to AS was not significant.
Treatment of this patient population with statins led to a significant reduction in mortality and also slowed the progression to AS--an effect that was not statistically significant with ACE-I treatment.
尽管主动脉硬化与不良心血管结局的增加有关，但尚无经证实的疗法可减缓其进展为明显的主动脉瓣狭窄（AS）。因此，对以下假说进行了评估：使用血管紧张素转换酶抑制剂（ACE-Is）、血管紧张素受体阻滞剂（ARBs）或他汀类药物治疗可能与这些患者临床结局的改善相关。
共识别出4105例经胸超声心动图显示有主动脉硬化证据的患者（定义为增厚或钙化，平均瓣膜压差≤15 mmHg）。对接受ACE-Is/ARBs或他汀类药物治疗的硬化瓣膜患者平均随访1078±615天。在对接受ACE-Is/ARBs或他汀类药物治疗的倾向进行调整后，评估死亡率、向AS的血流动力学进展、缺血性心脏病（IHD）住院率和充血性心力衰竭（CHF）住院率，并将其与药物治疗相关联。
在基线时，与未接受这些药物治疗的硬化瓣膜患者相比，接受ACE-I/ARB或他汀类药物治疗的主动脉硬化患者合并IHD、CHF、高血压、糖尿病和外周动脉疾病等合并症的情况更为严重。在对混杂因素进行调整后，他汀类药物治疗与死亡率显著降低相关（比值比[OR]0.73，95%可信区间0.56 - 0.98，p = 0.001），IHD住院率降低（OR 0.81，95%可信区间0.66 - 0.99，p = 0.03），CHF住院率降低（OR 0.68，95%可信区间0.55 - 0.85，p = 0.01）以及向AS进展降低（OR 0.64，95%可信区间0.42 - 0.97，p = 0.03）。虽然ACE-I治疗导致IHD住院率（OR 0.80，95%可信区间0.65 - 0.98，p = 0.03）和CHF住院率显著降低（OR 0.76，95%可信区间0.62 - 0.94，p = 0.01），但在降低死亡率和延缓向AS进展方面的有益趋势并不显著。
用他汀类药物治疗该患者群体可显著降低死亡率，并减缓向AS的进展——ACE-I治疗在这方面的效果无统计学意义。
