Issue: February 2023
Fact checked byRichard Smith

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January 04, 2023
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Use of statins, renin-angiotensin system inhibitors may improve 3-year survival after TAVR

Issue: February 2023
Fact checked byRichard Smith
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Among patients who underwent transcatheter aortic valve replacement, those who filled prescriptions for statins and ACE inhibitors or angiotensin receptor blockers had lower mortality risk at 3 years vs. those who did not, data show.

Perspective from Alexander C. Fanaroff, MD

Robert J. Cubeddu, MD, president of NCH Heart Institute in Naples, Florida, and colleagues analyzed Optum claims data from 9,012 patients (mean age, 80 years; 47% women) with aortic stenosis who underwent TAVR between 2014 and 2018. Patients were stratified by whether they filled prescriptions for statins and/or ACE inhibitors/angiotensin receptor blockers within 90 days after their procedure.

Pills in shape of heart_Adobe Stock
Among patients who underwent TAVR, those who filled prescriptions for statins and ACE inhibitors or ARBs had lower mortality risk at 3 years vs. those who did not.
Source: Adobe Stock

At 3 years, patients who filled a prescription for an ACE inhibitor/angiotensin receptor blocker had 18% reduced risk for mortality compared with those who did not (HR = 0.82; 95% CI, 0.74-0.91; P = .0003), while patients who filled a prescription for a statin had 15% reduced risk for mortality compared with those who did not (HR = 0.85; 95% CI, 0.77-0.94; P = .0018), according to the researchers.

Preoperative prescription of ACE inhibitors/angiotensin receptor blockers that was continued after the procedure was associated with improved 3-year survival compared with postoperative-only prescription, but the same was not true for statins, Cubeddu and colleagues wrote.

There was no association between beta-blocker prescription and 3-year survival, according to the researchers.

“This study’s real-world landmark analysis demonstrates an association between ACE inhibitors/angiotensin receptor blockers and/or statins following TAVR for aortic stenosis and improved patient survival while revealing the importance of continued ACE inhibitor/angiotensin receptor blocker prescription for those taking it pre-TAVR,” the researchers wrote. “Our study highlights the importance of pharmacotherapeutic management of patients for whom TAVR is anticipated or performed.”