Association between calcific aortic stenosis and hypercholesterolemia: Is there a need for a randomized controlled trial of cholesterol-lowering therapy?

Background: Calcific aortic stenosis may have common etiological factors wi th atherosclerosis. Hypothesis: In this retrospective, case-control study, we aimed to determin e whether there is an association between hypercholesterolemia and calcific aortic valve stenosis. Methods: Consecutive patients undergoing single aortic or mitral valve repl acement in a regional cardiothoracic surgical center were reviewed and preo perative patient characteristics were recorded: demographics, comorbidity ( including coronary artery disease and associated risk factors), serum total cholesterol, lipid-lowering therapy, and serum creatinine. Results: Serum total cholesterol concentrations were significantly higher i n patients with calcific aortic stenosis than in controls (6.2 +/- 1.1 vs. 5.3 +/- 1.1 mmol/l; p <0.001). The significant difference in serum choleste rol concentrations remained following collection for gender and body mass i ndex (p = 0.02) and when patients: with coronary artery disease were exclud ed (6.3 +/- 1.1 vs. 5.3 +/- 1.4 mmol/l; p <0.001). Subgroup analysis demons trated that the association between elevated serum cholesterol concentratio ns and calcific aortic stenosis was particularly strong in patients with tr icuspid aortic valves (6.4 +/- 1.2 vs. 5.3 +/- 1.1 mmol/l; p <0.001) compar ed with those with bicuspid valves (5.9 +/- 1.1 vs. 5.3 +/- 1.1 mmol/l; p = 0.06). Conclusions: We conclude that hypercholesterolemia is associated with calci fic aortic stenosis and may be implicated in its pathogenesis and professio n. We believe that there is now a need for a randomized, controlled trial o f cholesterol-lowering therapy in patients with calcific aortic stenosis.