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Previous Volume 352:2389-2397 June 9, 2005 Number 23 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Rosenhek, R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Calcific aortic stenosis has many characteristics in common with atherosclerosis, including hypercholesterolemia. We hypothesized that intensive lipid-lowering therapy would halt the progression of calcific aortic stenosis or induce its regression.

Methods In this double-blind, placebo-controlled trial, patients with calcific aortic stenosis were randomly assigned to receive either 80 mg of atorvastatin daily or a matched placebo. Aortic-valve stenosis and calcification were assessed with the use of Doppler echocardiography and helical computed tomography, respectively. The primary end points were change in aortic-jet velocity and aortic-valve calcium score.

Results Seventy-seven patients were assigned to atorvastatin and 78 to placebo, with a median follow-up of 25 months (range, 7 to 36). Serum low-density lipoprotein cholesterol concentrations remained at 130±30 mg per deciliter in the placebo group and fell to 63±23 mg per deciliter in the atorvastatin group (P<0.001). Increases in aortic-jet velocity were 0.199±0.210 m per second per year in the atorvastatin group and 0.203±0.208 m per second per year in the placebo group (P=0.95; adjusted mean difference, 0.002; 95 percent confidence interval, –0.066 to 0.070 m per second per year). Progression in valvular calcification was 22.3±21.0 percent per year in the atorvastatin group, and 21.7±19.8 percent per year in the placebo group (P=0.93; ratio of post-treatment aortic-valve calcium score, 0.998; 95 percent confidence interval, 0.947 to 1.050).

Conclusions Intensive lipid-lowering therapy does not halt the progression of calcific aortic stenosis or induce its regression. This study cannot exclude a small reduction in the rate of disease progression or a significant reduction in major clinical end points. Long-term, large-scale, randomized, controlled trials are needed to establish the role of statin therapy in patients with calcific aortic stenosis.

Source Information

From the Department of Cardiology, Royal Infirmary, Edinburgh (S.J.C., D.E.N., P.B., N.A.B.); Public Health Sciences, University of Edinburgh Medical School, Edinburgh (R.J.P.); the Department of Radiology, Borders General Hospital, Melrose, Roxburghshire, United Kingdom (J.R.); and the Department of Cardiology, Western General Hospital, Edinburgh (D.B.N.).

Address reprint requests to Dr. Newby at the Department of Cardiology, Royal Infirmary, Old Dalkeith Rd., Little France, Edinburgh EH16 4SU, United Kingdom, or at d.e.newby{at}ed.ac.uk.

Full Text of this Article

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Lipid-Lowering Therapy in Calcific Aortic Stenosis
Chan K. L., Teo K., Newby D. E., Northridge D. B., Boon N. A.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:1066-1067, Sep 8, 2005. Correspondence

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