Impact of metabolic syndrome on progression of aortic stenosis: influence of age and statin therapy
Romain Capoulade, Marie-Annick Clavel, Jean G Dumesnil, Kwan L Chan, Koon K Teo, James W Tam, Nancy Côté, Patrick Mathieu, Jean-Pierre Després, Philippe Pibarot, ASTRONOMER Investigators, Kwan Leung Chan, Ian Burwash, Susan Fagan, Bruce Sussex, Chris Koilpillai, Bruce Josephson, Jean G Dumesnil, Philippe Pibarot, George Honos, Jean Claude Tardif, Michele Turek, Trevor Robinson, Chi-Ming Chow, Sam Siu, Eric Yu, Cam Joyner, Chris Morgan, Charles Tomlinson, Koon Teo, James Tam, David Mymin, Nasir Shaikh, Davinder Jassal, Bibiana Cujec, Peter Giannoccaro, Brian Connelly, Peter Lougheed, Kenneth O'Reilly, William Hui, Ted Fenske, Alan Jones, Randy Williams, John Jue, Ken Gin, Pui-Kee Lee, Randall Sochowski, Dennis Morgan, Mangeet Mann, Ken Yvorchuk, Stephen Pearce, S Cheung, Raymond Dong, J M Kornder, Dante Manyari, Salima Shariff, Stuart Smith, Clause Rinne, Thao Huynh, Milan Gupta, David Borts, Anil Gupta, Nickie Bonafede, Shekhar Pandey, Romain Capoulade, Marie-Annick Clavel, Jean G Dumesnil, Kwan L Chan, Koon K Teo, James W Tam, Nancy Côté, Patrick Mathieu, Jean-Pierre Després, Philippe Pibarot, ASTRONOMER Investigators, Kwan Leung Chan, Ian Burwash, Susan Fagan, Bruce Sussex, Chris Koilpillai, Bruce Josephson, Jean G Dumesnil, Philippe Pibarot, George Honos, Jean Claude Tardif, Michele Turek, Trevor Robinson, Chi-Ming Chow, Sam Siu, Eric Yu, Cam Joyner, Chris Morgan, Charles Tomlinson, Koon Teo, James Tam, David Mymin, Nasir Shaikh, Davinder Jassal, Bibiana Cujec, Peter Giannoccaro, Brian Connelly, Peter Lougheed, Kenneth O'Reilly, William Hui, Ted Fenske, Alan Jones, Randy Williams, John Jue, Ken Gin, Pui-Kee Lee, Randall Sochowski, Dennis Morgan, Mangeet Mann, Ken Yvorchuk, Stephen Pearce, S Cheung, Raymond Dong, J M Kornder, Dante Manyari, Salima Shariff, Stuart Smith, Clause Rinne, Thao Huynh, Milan Gupta, David Borts, Anil Gupta, Nickie Bonafede, Shekhar Pandey
Abstract
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 ± 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 ± 0.21 m/s/year vs. +0.19 ± 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 ± 0.19 m/s/year vs. no MetS: +0.13 ± 0.18 m/s/year, p = 0.008) and among patients receiving statin therapy (+0.27 ± 0.23 m/s/year vs. +0.19 ± 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.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed