Impact of metabolic syndrome on progression of aortic stenosis: influence of age and statin therapy
JACC Cardiovascular Interventions, 07/16/2012
Capoulade R et al. – Metabolic syndrome (MetS) was found to be a powerful and independent predictor of faster aortic stenosis (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.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.
- 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.