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Impact of Baseline Severity of Aortic Valve Stenosis on Effect of Intensive Lipid Lowering Therapy (from the SEAS Study)

Gerdts, Eva; Rossebo, Anne Bjorhovde; Pedersen, Terje Rolf; Boman, Kurt; Brudi, Philippe; Chambers, John Boyd; Egstrup, Kenneth; Gohlke-Baerwolf, Christa; Holme, Ingar and Kesaniemi, Y. Antero, et al. (2010) In American Journal of Cardiology 106(11). p.1634-1639
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... (More)
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. (C) 2010 Published by Elsevier Inc. (Am J Cardiol 2010;106:1634-1639) (Less)
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American Journal of Cardiology
volume
106
issue
11
pages
1634 - 1639
publisher
Excerpta Medica
external identifiers
  • wos:000285125000018
  • scopus:78149452615
ISSN
1879-1913
DOI
10.1016/j.amjcard.2010.07.042
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English
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yes
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83a21f13-2473-4ca3-81b7-c22e4f5db287 (old id 1773613)
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2011-02-01 15:39:57
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@article{83a21f13-2473-4ca3-81b7-c22e4f5db287,
  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: &lt;= 2.8 m/s; tertile 2: &gt;2.8 to 3.3 m/s; tertile 3: &gt;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 &lt;0.05) and in the total study population (p &lt;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 &lt;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. (C) 2010 Published by Elsevier Inc. (Am J Cardiol 2010;106:1634-1639)},
  author       = {Gerdts, Eva and Rossebo, Anne Bjorhovde and Pedersen, Terje Rolf and Boman, Kurt and Brudi, Philippe and Chambers, John Boyd and Egstrup, Kenneth and Gohlke-Baerwolf, Christa and Holme, Ingar and Kesaniemi, Y. Antero and Malbecq, William and Nienaber, Christoph and Ray, Simon and Skjaerpe, Terje and Wachtell, Kristian and Willenheimer, Ronnie},
  issn         = {1879-1913},
  language     = {eng},
  number       = {11},
  pages        = {1634--1639},
  publisher    = {Excerpta Medica},
  series       = {American Journal of Cardiology},
  title        = {Impact of Baseline Severity of Aortic Valve Stenosis on Effect of Intensive Lipid Lowering Therapy (from the SEAS Study)},
  url          = {http://dx.doi.org/10.1016/j.amjcard.2010.07.042},
  volume       = {106},
  year         = {2010},
}