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Am Fam Physician. 2003;67(8):1800

No proven medical treatment is currently available that can delay or reverse the progression of aortic stenosis. New insight into the development and progression of aortic stenosis has resulted in the hypothesis that cholesterol may play a role, implying that lipid-lowering agents may slow progression of the disease. This association between aortic stenosis and hyperlipidemia has been inconsistent in the literature, with some studies reporting a positive correlation and others reporting little or no correlation. Bellamy and associates conducted a community-based study to analyze the effect of hyperlipidemia on the progression of aortic stenosis and to evaluate the impact of lipid-lowering agents, particularly statins, on this progression.

Participants in the study were obtained by screening all adults with aortic stenosis in one county from January 1987 to March 2000. Aortic stenosis was defined as an aortic mean gradient of at least 10 mm Hg and an aortic valve area of 2.0 cm2 or less. Additional information assessed included cholesterol level, age, gender, etiology of valvular stenosis, smoking history, and diagnosis of other chronic diseases such as hypertension, diabetes, and coronary disease. A second echo-cardiogram of the aortic valve was obtained at least six months after the initial measurement, and the value used for the study was the most recent measurement or last performed before the aortic valve replacement surgery. In addition, all drug treatments given to the subjects who participated in the study were recorded. A total of 156 subjects were enrolled in the study, of which 38 subjects received lipid-lowering treatment during the follow-up period.

In the 118 participants who did not receive any statin therapy, the aortic valve mean gradient increased from 22 mm Hg to 39 mm Hg and the aortic valve area decreased from 1.20 cm2 to 0.92 cm2. The annualized decrease in the aortic valve area was 0.09 cm2 per year.

No correlation was found between the total cholesterol or low-density cholesterol levels and the progression of aortic stenosis. Progression of aortic stenosis was significantly slower in patients receiving statin therapy when compared with those who did not receive this class of medications, even when controlling for other variables. The association between statin therapy and slower progression of aortic stenosis was confirmed when the analysis was restricted to patients presenting for systematic follow-up.

The authors conclude that in a community-based population, the progression of aortic stenosis is not correlated with cholesterol levels. The authors add that patients who are receiving statin therapy experience slower progression of aortic stenosis. The results of this study suggest that there is a promise of safe and effective medical treatment for aortic stenosis.

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