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Angiotensin receptor blockers may decrease mortality risk in calcific aortic stenosis
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Angiotensin receptor blockers could potentially reduce the risk for mortality by 30% during an 8-year period for patients with calcific aortic stenosis, a presenter said at the Canadian Cardiovascular Congress.
“Our discovery shifts how we think about aortic stenosis by looking at a new pathway that both prevents and reverses calcification,” Philippe Pibarot, DMV, PhD, professor at Laval University and Canada Research Chair in Valvular Heart Disease at Quebec Heart and Lung Institute, said in a press release. “It broadens how we can approach therapies, opening up new avenues of research and has tremendous potential to lead a major discovery.”
Pibarot and colleagues conducted a study to examine the effect of ACE inhibitors and angiotensin receptor blockers (ARBs) on the progression of calcific aortic stenosis. During a mean follow-up of 3.9 years, 340 patients with calcific aortic stenosis and preserved left ventricular ejection fraction were assigned to ACE inhibitors (34%), ARBs (16%) or no renin-angiotensin system medication (50%). The researchers used annualized increase in peak aortic jet velocity (Vpeak) to evaluate calcific aortic stenosis progression rate.
At baseline, severity in patients with calcific aortic stenosis was similar among those assigned to ARBs, ACE inhibitors and no renin-angiotensin system medication (Vpeak: 2.8 vs. 2.8 vs. 2.9 m/s, respectively). In patients assigned to ARBs, the progression rate of Vpeak was lower (0.12 m/s per year; P=.01) vs. patients assigned to no renin-angiotensin system medication (0.22 m/s per year) and ACE inhibitors (0.19 m/s per year), according to data Pibarot presented.
The researchers also found that ARBs were associated with a slower (P=.0003) and reduced (P=.006) progression of calcific aortic stenosis, but the same effects were not seen with ACE inhibitors. ARBs remained predictive of slower calcific aortic stenosis progression after adjustment for propensity score (P=.005). Baseline Vpeak (P=.0004) and diabetes (P=.02) were identified as other predictors of calcific aortic stenosis at baseline. Overall, researchers found patients taking renin-angiotensin system inhibitors were older (71 years vs. 66 years; P=.0009) and had more hypertension (100% vs. 46%; P<.0001), CAD (56% vs. 31%; P<.0001), hyperlipidemia (66% vs. 46%; P<.0001) and diabetes (33% vs. 12%; P<.0001).
“Aortic stenosis is one of the most common types of heart disease, yet the only option to save lives has been open heart surgery … and valve replacement surgery is the second most frequent heart surgery after coronary artery bypass,” Pibarot said. “We may be able to slow the progress of aortic stenosis to the point that most people won’t need surgery.”
Disclosure: Dr. Pibarot reports no relevant financial disclosures.
For more information:
- Capoulade R. #461. Presented at: 2011 Canadian Cardiovascular Congress; Oct. 24-26; Vancouver, British Columbia.
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