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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Overview of clinical trials on calcific aortic stenosis

Terje R. Pedersen*

Centre for Preventive Medicine, Ullevål University Hospital, Building 19, Kirkeveien 166 N-0407 Oslo, Norway

* Corresponding author. Tel: +47 22 11 79 32; fax: +47 22 60 19 00. E-mail address: t.r.pedersen{at}medisin.uio.no

Lipid-lowering therapy may slow the progression of calcific aortic stenosis (AS). Three completed studies on the effect of statin therapy on AS, as well as two ongoing trials, are summarised. Evidence that lipid-lowering therapy slows the progression of AS relative to non-statin therapy has been suggested by several retrospective studies. Further evidence that statin treatment can slow the progression of AS derives from the prospective (non-randomised), open-label Rosuvastatin Affecting Aortic Valve Endothelium (RAAVE) study, which was potentially subject to bias, but not by the randomised, double-blind, placebo-controlled Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression (SALTIRE) study, which enrolled 155 patients and had a follow-up period of 2.1 years. At present, two larger randomised clinical trials in AS are ongoing with a longer duration than the SALTIRE study. The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study with 1873 patients has the longest planned treatment duration (4–7 years), while the Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin (ASTRONOMER) trial includes 272 patients with AS who are receiving rosuvastatin 40 mg/day or placebo for 3–5 years and is designed to study progression of the disease. These and other ongoing studies are intended to evaluate the effects of lipid-lowering therapy on AS progression and aortic valve degradation, as well as the need for surgical valve replacement and mortality and morbidity, in patients with AS. Findings from recent clinical studies on lipid-lowering therapy for the management of AS (e.g. SALTIRE and RAAVE trials) are somewhat contradictory. The ongoing clinical trials—the SEAS study and the ASTRONOMER study—will probably resolve the question of the benefit of intensive lipid-lowering treatment in AS.

Key Words: Aortic stenosis • Aortic valve replacement • Echocardiography • Cardiovascular disease • Lipid-lowering therapy


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