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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Metabolic Syndrome Negatively Influences Disease Progression and Prognosis in Aortic Stenosis

Martin Briand, MS^_*, Isabelle Lemieux, PhD^_*, Jean G. Dumesnil, MD, FACC^_*, Patrick Mathieu, MD^_*, Amélie Cartier, MS^_*, Jean-Pierre Després, PhD, FAHA^_*,, Marie Arsenault, MD^_*, Jacques Couet, PhD^_* and Philippe Pibarot, DVM, PhD, FACC^_*,_*

^_* Laval Hospital Research Center/Québec Heart Institute, Department of Medicine, Laval University
Division of Kinesiology, Department of Social and Preventive Medicine, Laval University, Québec, Canada

Manuscript received September 7, 2005; revised manuscript received December 19, 2005, accepted December 30, 2005.

^_* Reprint requests and correspondence: Dr. Philippe Pibarot, Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V-4G5 (Email: philippe.pibarot{at}med.ulaval.ca).

OBJECTIVES: This study sought to examine the association between the metabolic syndrome (MS) and the progression of aortic stenosis (AS).

BACKGROUND: It has been suggested that aortic valve sclerosis and its progression to AS are caused by an atherosclerotic process. Metabolic syndrome is associated with a higher risk of vascular atherosclerosis. Thus, we hypothesized that the atherogenic features of MS could negatively influence disease progression and prognosis in patients with AS.

METHODS: We retrospectively analyzed the data of 105 consecutive patients (age 69 ± 12 years, 64 men) with at least moderate AS. Of these patients, 40 (38%) had MS identified according to the modified clinical criteria proposed by the National Cholesterol Education Program-Adult Treatment Panel III. The hemodynamic progression of AS was assessed by the measurement of the annualized decrease in valve area during the follow-up period of the study, which averaged 28 ± 13 months. Event-free survival was defined as the absence of death or aortic valve replacement during follow-up.

RESULTS: The hemodynamic progression of the stenosis was twice as fast (–0.14 ± 0.13 cm²/year vs. –0.08 ± 0.08 cm²/year, p = 0.008) and the three-year event-free survival was markedly lower (44 ± 8% vs. 69 ± 6%, p = 0.002) among patients with MS. In multivariate analysis, MS was found to be a strong independent predictor of both stenosis progression (p = 0.006) and event-free survival (odds ratio 3.85, 95% CI 1.96 to 7.58, p < 0.001).

CONCLUSIONS: The present study is the first to report that MS is associated with a faster disease progression and worse outcome in patients with AS. Such findings open new avenues of research and provide a strong impetus for the elaboration of additional prospective studies focusing on this association.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AS = aortic stenosis   AVA = aortic valve area   AVR = aortic valve replacement   CRP = C-reactive protein   HDL = high-density lipoprotein   LDL = low-density lipoprotein   MS = metabolic syndrome   NCEP-ATPIII = National Cholesterol Education Program-Adult Treatment Panel III

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