Marco-Benedí Victoria, Laclaustra Martin, Casado-Dominguez Juan M, Villa-Pobo Rosa, Mateo-Gallego Rocío, Sánchez-Hernández Rosa M, Blanco Nuez Marta, Ortega-Martínez de Victoria Emilio, Sitges Marta, Pedro-Botet Juan, Puzo Jose, Villarroel Teresa, Civeira Fernando
Lipid Unit, Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, 50009 Zaragoza, Spain.
Cardiology Department, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain.
J Clin Med. 2019 Dec 14;8(12):2209. doi: 10.3390/jcm8122209.
Hypercholesterolemia and statins are risk factors for aortic stenosis (AS) and vascular calcification, respectively. Whether heterozygous subjects with familial hypercholesterolemia (HeFH) treated with statins are at risk of AS is unknown. We study the prevalence of AS, aortic valve calcification (AoVC), and aortic sclerosis (ASc) in elderly subjects with HeFH in a prolonged statin treatment. Case-control study, cases were adults ≥65 years of age with a genetic diagnosis of HeFH, LDLc >220 mg/dl, and statin treatment ≥5 years. Controls were relatives of HeFH patients, with LDLc <190 mg/dl. Participants underwent a cardiac ultrasound for aortic valve analysis. We studied 205 subjects, 112 HeFH and 93 controls, with mean age 71.8(6.5) years and 70.0(7.3) years, respectively. HeHF, with respect to controls, presented greater gradients of aortic transvalvular pressure, 7.4(7.3) mmHg versus 5.0(2.8) mmHg, and maximum aortic velocity, 1.7(0.7) m/s versus 1.5(0.4) m/s, and lower aortic valve opening area, 2.0(0.7) cm versus 2.4(0.6) cm (all < 0.05). AoVC and ASc were also more prevalent in HeFH ( < 0.05 between groups). Moderate/severe AS prevalence was higher among HeFH: 7.1% versus 1.1% (age- and sex-adjusted odds ratio (OR) 8.33, = 0.03). Independent risk factors for aortic valve disease in HeFH were age and LDLc before treatment. The number of years under statin treatment was not associated with any aortic valve measurement. Subjects ≥65 years with HeFH in prolonged statin treatment show more aortic valvular disease and higher frequency of AS than controls. Life-long elevated LDLc exposure, rather than time of exposure to statins, explains this higher risk.
高胆固醇血症和他汀类药物分别是主动脉瓣狭窄（AS）和血管钙化的危险因素。他汀类药物治疗的家族性高胆固醇血症（HeFH）杂合子受试者是否有患AS的风险尚不清楚。我们研究了长期接受他汀类药物治疗的老年HeFH受试者中AS、主动脉瓣钙化（AoVC）和主动脉硬化（ASc）的患病率。病例对照研究，病例为年龄≥65岁、基因诊断为HeFH、低密度脂蛋白胆固醇（LDLc）>220mg/dl且他汀类药物治疗≥5年的成年人。对照为HeFH患者的亲属，LDLc<190mg/dl。参与者接受心脏超声检查以分析主动脉瓣。我们研究了205名受试者，112名HeFH患者和93名对照，平均年龄分别为71.8（6.5）岁和70.0（7.3）岁。与对照组相比，HeHF患者的主动脉跨瓣压差更大，分别为7.4（7.3）mmHg和5.0（2.8）mmHg，最大主动脉流速更高，分别为1.7（0.7）m/s和1.5（0.4）m/s，主动脉瓣开放面积更小，分别为2.0（0.7）cm和2.4（0.6）cm（均P<0.05）。AoVC和ASc在HeFH患者中也更常见（组间P<0.05）。HeFH患者中中度/重度AS的患病率更高：7.1%对1.1%（年龄和性别调整后的优势比（OR）为8.33，P=0.03）。HeFH患者主动脉瓣疾病的独立危险因素是年龄和治疗前的LDLc。他汀类药物治疗的年限与任何主动脉瓣测量指标均无关联。长期接受他汀类药物治疗的≥65岁HeFH患者比对照组表现出更多的主动脉瓣疾病和更高的AS发生率。终生LDLc升高的暴露情况而非他汀类药物的暴露时间解释了这种更高的风险。
