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Abstract Title:

Impact of baseline severity of aortic valve stenosis on effect of intensive lipid lowering therapy (from the SEAS study).

Abstract Source:

Am J Cardiol. 2010 Dec 1;106(11):1634-9. Epub 2010 Oct 14. PMID: 21094366

Abstract Author(s):

Eva Gerdts, Anne Bjørhovde Rossebø, Terje Rolf Pedersen, Kurt Boman, Philippe Brudi, John Boyd Chambers, Kenneth Egstrup, Christa Gohlke-Bärwolf, Ingar Holme, Y Antero Kesäniemi, William Malbecq, Christoph Nienaber, Simon Ray, Terje Skjærpe, Kristian Wachtell, Ronnie Willenheimer

Article Affiliation:

Institute of Medicine, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Abstract:

Retrospective studies have suggested a beneficial effect of lipid-lowering treatment on the progression of aortic stenosis (AS) in milder stages of the disease. In the randomized, placebo-controlled Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, 4.3 years of combined treatment with simvastatin 40 mg and ezetimibe 10 mg did not reduce aortic valve events (AVEs), while ischemic cardiovascular events (ICEs) were significantly reduced in the overall study population. However, the impact of baseline AS severity on treatment effect has not been reported. Baseline and outcomes data in 1,763 SEAS patients (mean age 67 years, 39% women) were used. The study population was divided into tertiles of baseline peak aortic jet velocity (tertile 1:≤2.8 m/s; tertile 2:>2.8 to 3.3 m/s; tertile 3:>3.3 m/s). Treatment effect and interaction were tested in Cox regression analyses. The rates of AVEs and ICEs increased with increasing baseline severity of AS. In Cox regression analyses, higher baseline peak aortic jet velocity predicted higher rates of AVEs and ICEs in all tertiles (all p values<0.05) and in the total study population (p<0.001). Simvastatin-ezetimibe treatment was not associated with a statistically significant reduction in AVEs in any individual tertile. A significant quantitative interaction between the severity of AS and simvastatin-ezetimibe treatment effect was demonstrated for ICEs (p<0.05) but not for AVEs (p = 0.10). In conclusion, the SEAS study results demonstrate a strong relation between baseline the severity of AS and the rate of cardiovascular events but no significant effect of lipid-lowering treatment on AVEs, even in the group with the mildest AS.

Study Type : Meta Analysis

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