Statins can slow the progression of aortic valve stenosis, a condition in which the heart valve that pumps blood out into the body becomes hard and narrow, in people with mild to moderate disease.
To be published in the February 6 issue of the Journal of the American College of Cardiology, the trial provides the first prospective clinical evidence that aortic valves have an active biology that can be targeted with medical therapy and contradicts research published in 2005 in the New England Journal of Medicine, which concluded statins did not halt the progression of aortic stenosis.
"For decades, the medical community has accepted that aortic valve disease was part of the aging process and that replacing valves surgically was the only treatment," says senior investigator Nalini Rajamannan, MD, director of the Center for Heart Valve Disease in the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital and assistant professor of medicine, Northwestern University Feinberg School of Medicine. "Now we have clinical evidence showing a medical treatment can delay the need for surgery. I see a lot of patients in their 50s being diagnosed with early stage valve disease that don't like hearing that the next step is watchful waiting until eventually they'll require open heart surgery. For them, this is great news."
The RAAVE (Rosuvastatin Affecting Aortic Valve Endothelium to Slow the Progression of Aortic Stenosis) trial was conducted at the Hospital Pedro Hispano in Portugal and led by principal investigator Luis Moura, MD, and followed 121 patients with asymptomatic moderate to severe narrowing of the aortic valve for 18 months. Sixty-one patients with elevated cholesterol levels were given 20mg/day of the statin Crestor, an average daily dose, while the other 60 patients who did not have elevated cholesterol levels received no statin. The statin group showed significant improvement in cholesterol levels as well as a 50% improvement in the slowing of the progression of the valvular heart disease at 1.5 years.
Last year's widely publicized study done by researchers in the United Kingdom called SALTIRE discredited the idea that statins had a role as an aortic stenosis therapy. "But the patients in that study had largely advanced aortic disease," says Dr. Rajamannan. "If patients' valves are already significantly narrowed, you're not going to be able to reverse it and patients are going to progress to surgery. The key is to catch them early."