Statins for aortic valve stenosis

Statins for aortic valve stenosis

Author Thiago, Luciana Google Scholar
Tsuji, Selma Rumiko Google Scholar
Nyong, Jonathan Google Scholar
Puga, Maria E. S. Autor UNIFESP Google Scholar
Gois, Aecio F. T. Autor UNIFESP Google Scholar
Macedo, Cristiane R. Autor UNIFESP Google Scholar
Valente, Orsine Autor UNIFESP Google Scholar
Atallah, Alvaro N. Autor UNIFESP Google Scholar
Abstract Background Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. Objectives To evaluate the effectiveness and safety of statins in aortic valve stenosis. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria Randomised controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalisation for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. Main results We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80

participants = 1935

studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14

participants = 127

studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14

participants = 155

study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06

participants = 2360

studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09

participants = 2204

studies = 3

moderate-quality evidence). Low-and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15

participants = 2297

studies = 3

low-quality evidence) and hospitalisation for any reason (RR 0.84, 95% CI 0.39 to 1.84

participants = 155

study = 1

very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. Authors' conclusions Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.
Keywords Systematic Reviews
Language English
Sponsor Brazilian Cochrane Centre, Federal University of Sao Paulo and Marilia Medical, Brazil
Date 2016
Published in Cochrane Database Of Systematic Reviews. Hoboken, n. 9, p. CD009571, 2016.
ISSN 1469-493X (Sherpa/Romeo, impact factor)
Publisher Inst Oceanografico, Univ Sao Paulo
Extent CD009571
Access rights Open access Open Access
Type Revisão
Web of Science ID WOS:000389598700034

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