Effect of hydroxymethylglutaryl coenzyme A reductase inhibitors on the progression of calcific aortic stenosis

Background-Recent studies have supported the hypothesis that calcific aorti c stenosis is the product of an active inflammatory process, with similarit ies to atherosclerosis. We sought to determine whether therapy with hydroxy methylglutaryl coenzyme A reductase inhibitors (statins) might slow the pro gression of aortic stenosis. Methods and Results-A retrospective study of 174 patients (mean age 68 +/- 12 years) with mild to moderate calcific aortic stenosis was conducted. Pat ients required normal left ventricular function, less than or equal to2+ ao rtic regurgitation, and greater than or equal to2 echocardiograms performed at least 12 months apart. Fifty-seven patients (33%) received treatment wi th a statin; the remaining 117 (67%) did not. The statin group was older an d had a higher prevalence of hypertension, diabetes mellitus, and coronary disease. During a mean follow-up of 21 months, patients treated with statin had a smaller increase in peak and mean gradient and a smaller decrease in aortic valve area. When annualized, the decrease in aortic valve area for the nonstatin group was 0.11 +/-0.18 cm(2) compared with 0.06 +/-0.16 cm(2) for those treated with a statin (P=0.03). In multivariate analysis, statin usage was a significant independent predictor of a smaller decrease in val ve area (P=0.01) and a lesser increase in peak gradient (P=0.02). Conclusions-Statin-treated patients, despite a higher risk profile for prog ression, had reduced aortic stenosis progression compared with those not tr eated with a statin. These data provide justification for a prospective ran domized trial to substantiate whether statin therapy slows the progression of aortic stenosis.