CORRESPONDENCE: LETTER TO THE EDITOR
Statins and Aortic Stenosis in the Context of Ratio of Low- to High-Density Lipoprotein Cholesterol
Mehmet Birhan Yilmaz, MD*
* Cardiology, Cumhuriyet University School of Medicine, Harun Efendi Apt C Blok Daire 1, Atatürk Caddesi, Sivas, Sivas 58140, Turkey (Email: cardioceptor{at}gmail.com).
In a recent paper by Moura et al. (1), it was found that lipid-lowering therapy with a statin, namely, rosuvastatin, showed beneficial effects in slowing the progression of the aortic stenosis. Aortic stenosis has long been associated with atherosclerosis by many authors in the context of common risk factors with common pathophysiologic scenarios (2,3). The lipid hypothesis is one of the most enthusiastic ones, attracting attention after Otto et al. (2) showed that aortic valve disease behaved in an almost similar manner as atherosclerosis on microscopic samples, although there were some differences, particularly, more influence of calcification. This enthusiasm brought about a prospective study (4), which failed to show any beneficial effect on valve disease progression despite significant decrease in low-density lipoprotein (LDL) cholesterol with atorvastatin in a group of patients with heavily calcified aortic stenosis. This issue is also mentioned in the recent paper (1), and the potential difference is attributed to the difference in the severity of the aortic disease, which could definitely be accepted as one of the answers. In addition to this point, in the paper it was (1) stated that there was a significant correlation (1) between the LDL decrease, which was almost similar to that in the earlier study (4), and the progression of the aortic disease, which was definitely not correlated with LDL cholesterol in the previous study (4). On the other hand, what is not presented nor mentioned in either paper is that both statins are known to differ in terms of their effects on high-density lipoprotein (HDL) cholesterol, and the LDL to HDL cholesterol ratio (5). In our study (6), we had shown that there was a significant correlation between the rate of aortic valve disease progression and the total cholesterol to HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios. It is rational within this concept to expect that better normalization, which has been shown to be significantly better with rosuvastatin (5), might yield better results. Neither of the 2 studies (1,4) pointed this out. We think that in addition to the severity of the aortic valve disease, a delicate balance of lipid profile with HDL cholesterol behaving in opposition to LDL cholesterol might have a significant role in aortic stenosis progression just as in atherosclerosis. However, this issue remains to be established.
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References
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- Moura LM, Ramos SF, Zamorano JL, et al. Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis J Am Coll Cardiol 2007;49:554-561.[Abstract/Free Full Text]
- Otto CM, Kuusisto J, Reichenbach DD, Gown AM, O’Brien KD. Characterization of the early lesion of "degenerative" valvular aortic stenosis: histological and immunohistochemical studies Circulation 1994;90:844-853.[Abstract/Free Full Text]
- Otto CM. Aortic stenosis and hyperlipidemia: establishing a cause-effect relationship Am Heart J 2004;147:761-763.[CrossRef][ISI][Medline]
- Cowell SJ, Newby DE, Prescott RJ, et al. Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression (SALTIRE) Investigators A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis N Engl J Med 2005;352:2389-2397.[Abstract/Free Full Text]
- Jukema JW, Liem AH, Dunselman PH, van der Sloot JA, Lok DJ, Zwinderman AH. LDL-C/HDL-C ratio in subjects with cardiovascular disease and a low HDL-C: results of the RADAR (Rosuvastatin and Atorvastatin in Different Dosages and Reverse Cholesterol Transport) study Curr Med Res Opin 2005;21:1865-1874.[CrossRef][ISI][Medline]
- Yilmaz MB, Guray U, Guray Y, et al. Lipid profile of patients with aortic stenosis might be predictive of rate of progression Am Heart J 2004;147:915-918.[CrossRef][ISI][Medline]
Related Article
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Reply
- Luis M. Moura, José L. Zamorano, Sandra F. Ramos, Isabel M. Barros, Luis F. Azevedo, F. Rocha-Gonçalves, and Nalini M. Rajamannan
J. Am. Coll. Cardiol. 2007 50: 290.
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