Impact of Metabolic Syndrome on Progression of Aortic Stenosis: Influence of Age and Statin Therapy

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• 作者：Romain Capoulade ; Marie-Annick Clavel ; Jean G. Dumesnil ; Kwan L. Chan ; Koon K. Teo ; James W. Tam ; Nancy C?t¨¦ ; Patrick Mathieu ; Jean-Pierre Despr¨¦s ; Philippe Pibarot ; ASTRONOMER Investigators
• 关键词：aortic stenosis ; Doppler echocardiography ; metabolic syndrome ; obesity ; statins
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 出版时间：17 July, 2012
• 年：2012
• 卷：60
• 期：3
• 页码：216-223
• 全文大小：435 K

文摘

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Objectives

The aims of this study were to examine prospectively the relationship between metabolic syndrome (MetS) and aortic stenosis (AS) progression and to evaluate the effect of age and statin therapy on AS progression in patients with or without MetS.

Background

Despite the clear benefits of statin therapy in primary and secondary coronary heart disease prevention, several recent randomized trials have failed to demonstrate any significant effect of this class of drugs on the progression of AS. Previous retrospective studies have reported an association between MetS and faster AS progression.

Methods

This predefined substudy included 243 of the 269 patients enrolled in the ASTRONOMER (AS Progression Observation: Measuring Effects of Rosuvastatin) trial. Follow-up was 3.4 ¡À 1.3 years. AS progression rate was measured by calculating the annualized increase in peak aortic jet velocity measured by Doppler echocardiography.

Results

Patients with MetS (27 % ) had faster stenosis progression (+0.25 ¡À 0.21 m/s/year vs. +0.19 ¡À 0.19 m/s/year, p = 0.03). Predictors of faster AS progression in multivariate analysis were older age (p = 0.01), higher degree of valve calcification (p = 0.01), higher peak aortic jet velocity at baseline (p = 0.007), and MetS (p = 0.005). Impact of MetS on AS progression was most significant in younger (< 57 years) patients (MetS: +0.24 ¡À 0.19 m/s/year vs. no MetS: +0.13 ¡À 0.18 m/s/year, p = 0.008) and among patients receiving statin therapy (+0.27 ¡À 0.23 m/s/year vs. +0.19 ¡À 0.18 m/s/year, p = 0.045). In multivariate analysis, the MetS-age interaction was significant (p = 0.01), but the MetS-statin use interaction was not.

Conclusions

MetS was found to be a powerful and independent predictor of faster AS progression, with more pronounced impact in younger patients. These findings emphasize the importance of routinely identifying and treating MetS in AS patients. The apparent faster stenosis progression in the subset of normocholesterolemic patients with MetS receiving the statin will need to be confirmed by future studies.