Impact of high-dose atorvastatin therapy and clinical risk factors on incident aortic valve stenosis in patients with cardiovascular disease (from TNT, IDEAL, and SPARCL).
Identifieur interne : 003824 ( Main/Exploration ); précédent : 003823; suivant : 003825Impact of high-dose atorvastatin therapy and clinical risk factors on incident aortic valve stenosis in patients with cardiovascular disease (from TNT, IDEAL, and SPARCL).
Auteurs : Benoit J. Arsenault [Canada] ; S Matthijs Boekholdt [Pays-Bas] ; Samia Mora [États-Unis] ; David A. Demicco [États-Unis] ; Weihang Bao [États-Unis] ; Jean-Claude Tardif [Canada] ; Pierre Amarenco [France] ; Terje Pedersen [Norvège] ; Philip Barter [Australie] ; David D. Waters [États-Unis]Source :
- The American journal of cardiology [ 1879-1913 ] ; 2014.
Descripteurs français
- KwdFr :
- Acides heptanoïques (administration et posologie), Administration par voie orale, Adulte d'âge moyen, Anticholestérolémiants (administration et posologie), Atorvastatine de calcium, Cholestérol (sang), Facteurs de risque, Facteurs temps, Femelle, Humains, Incidence, Maladie coronarienne (), Maladie coronarienne (sang), Maladie coronarienne (traitement médicamenteux), Mâle, Pronostic, Pyrroles (administration et posologie), Relation dose-effet des médicaments, Santé mondiale, Sténose aortique (), Sténose aortique (épidémiologie), Sténose aortique (étiologie), Sujet âgé, Sujet âgé de 80 ans ou plus, Études de suivi.
- MESH :
- administration et posologie : Acides heptanoïques, Anticholestérolémiants, Pyrroles.
- sang : Cholestérol, Maladie coronarienne.
- traitement médicamenteux : Maladie coronarienne.
- épidémiologie : Sténose aortique.
- étiologie : Sténose aortique.
- Administration par voie orale, Adulte d'âge moyen, Atorvastatine de calcium, Facteurs de risque, Facteurs temps, Femelle, Humains, Incidence, Maladie coronarienne, Mâle, Pronostic, Relation dose-effet des médicaments, Santé mondiale, Sténose aortique, Sujet âgé, Sujet âgé de 80 ans ou plus, Études de suivi.
English descriptors
- KwdEn :
- Administration, Oral, Aged, Aged, 80 and over, Anticholesteremic Agents (administration & dosage), Aortic Valve Stenosis (epidemiology), Aortic Valve Stenosis (etiology), Aortic Valve Stenosis (prevention & control), Atorvastatin Calcium, Cholesterol (blood), Coronary Disease (blood), Coronary Disease (complications), Coronary Disease (drug therapy), Dose-Response Relationship, Drug, Female, Follow-Up Studies, Global Health, Heptanoic Acids (administration & dosage), Humans, Incidence, Male, Middle Aged, Prognosis, Pyrroles (administration & dosage), Risk Factors, Time Factors.
- MESH :
- chemical , administration & dosage : Anticholesteremic Agents, Heptanoic Acids, Pyrroles.
- chemical , blood : Cholesterol.
- blood : Coronary Disease.
- complications : Coronary Disease.
- drug therapy : Coronary Disease.
- epidemiology : Aortic Valve Stenosis.
- etiology : Aortic Valve Stenosis.
- prevention & control : Aortic Valve Stenosis.
- Administration, Oral, Aged, Aged, 80 and over, Atorvastatin Calcium, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Global Health, Humans, Incidence, Male, Middle Aged, Prognosis, Risk Factors, Time Factors.
Abstract
Clinical trials have not provided evidence for a role of statin therapy in reducing aortic valve stenosis (AVS) severity in patients with documented AVS. However, whether statin therapy could prevent the onset of AVS is unknown. Our objectives were (1) to compare the incidence rates of AVS among patients treated with high-dose versus usual-dose statin or placebo and (2) to identify clinical risk factors associated with the development of AVS. We conducted post hoc analyses in 23,508 participants from 3 large-scale multicenter atorvastatin randomized blinded clinical trials: Treating to New Targets, the Incremental Decrease in End Points Through Aggressive Lipid Lowering, and the Stroke Prevention by Aggressive Reduction in Cholesterol Levels. The main outcome measure was the incidence of clinical AVS over a median follow-up of 4.9 years (82 cases). Among patients who developed AVS, 39 (47.6%) were treated with atorvastatin 80 mg and 43 (52.4%) were treated with lower dose statin (atorvastatin 10 mg in Treating to New Targets, simvastatin 20 to 40 mg in Incremental Decrease in End Points Through Aggressive Lipid Lowering, or placebo in Stroke Prevention by Aggressive Reduction in Cholesterol Levels; hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.59 to 1.41, p=0.67). In multivariate analyses forcing treatment, sex, and race into the model, factors that were significantly associated with AVS included age (HR 2.17, 95% CI 1.61 to 2.93, p<0.0001 per 1-SD increment), diabetes (HR 1.67, 95% CI 1.00 to 2.80, p=0.05), vitamin K antagonist use (HR 3.25, 95% CI 2.06 to 5.16, p<0.0001), and previous statin use (HR 2.65, 95% CI 1.54 to 4.60, p=0.0008). In conclusion, random allocation to high-dose versus usual-dose statin therapy or placebo did not impact the incidence of AVS among patients without known AVS. Age, diabetes, vitamin K antagonists, and previous statin use were significant predictors of incident AVS in these high-risk patients.
DOI: 10.1016/j.amjcard.2014.01.414
PubMed: 24582532
Affiliations:
- Australie, Canada, France, Norvège, Pays-Bas, États-Unis
- Californie, Hollande-Septentrionale, Massachusetts, Nouvelle-Galles du Sud, Québec, État de New York, Île-de-France, Østlandet
- Amsterdam, Montréal, Oslo, Paris, Sydney
- Université d'Amsterdam
Links toward previous steps (curation, corpus...)
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Le document en format XML
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Waters</name><affiliation wicri:level="2"><nlm:affiliation>San Francisco General Hospital, San Francisco, California. Electronic address: dwaters@medsfgh.ucsf.edu.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>San Francisco General Hospital, San Francisco</wicri:cityArea></affiliation></author></analytic><series><title level="j">The American journal of cardiology</title><idno type="eISSN">1879-1913</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Administration, Oral</term><term>Aged</term><term>Aged, 80 and over</term><term>Anticholesteremic Agents (administration & dosage)</term><term>Aortic Valve Stenosis (epidemiology)</term><term>Aortic Valve Stenosis (etiology)</term><term>Aortic Valve Stenosis (prevention & control)</term><term>Atorvastatin Calcium</term><term>Cholesterol (blood)</term><term>Coronary Disease (blood)</term><term>Coronary Disease (complications)</term><term>Coronary Disease (drug therapy)</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Follow-Up Studies</term><term>Global Health</term><term>Heptanoic Acids (administration & dosage)</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Prognosis</term><term>Pyrroles (administration & dosage)</term><term>Risk Factors</term><term>Time Factors</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acides heptanoïques (administration et posologie)</term><term>Administration par voie orale</term><term>Adulte d'âge moyen</term><term>Anticholestérolémiants (administration et posologie)</term><term>Atorvastatine de calcium</term><term>Cholestérol (sang)</term><term>Facteurs de risque</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Maladie coronarienne ()</term><term>Maladie coronarienne (sang)</term><term>Maladie coronarienne (traitement médicamenteux)</term><term>Mâle</term><term>Pronostic</term><term>Pyrroles (administration et posologie)</term><term>Relation dose-effet des médicaments</term><term>Santé mondiale</term><term>Sténose aortique ()</term><term>Sténose aortique (épidémiologie)</term><term>Sténose aortique (étiologie)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Études de suivi</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Anticholesteremic Agents</term><term>Heptanoic Acids</term><term>Pyrroles</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Cholesterol</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Acides heptanoïques</term><term>Anticholestérolémiants</term><term>Pyrroles</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Coronary Disease</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronary Disease</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronary Disease</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Aortic Valve Stenosis</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Aortic Valve Stenosis</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Aortic Valve Stenosis</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Cholestérol</term><term>Maladie coronarienne</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Maladie coronarienne</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Sténose aortique</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Sténose aortique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Administration, Oral</term><term>Aged</term><term>Aged, 80 and over</term><term>Atorvastatin Calcium</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Follow-Up Studies</term><term>Global Health</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Prognosis</term><term>Risk Factors</term><term>Time Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Administration par voie orale</term><term>Adulte d'âge moyen</term><term>Atorvastatine de calcium</term><term>Facteurs de risque</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Maladie coronarienne</term><term>Mâle</term><term>Pronostic</term><term>Relation dose-effet des médicaments</term><term>Santé mondiale</term><term>Sténose aortique</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Études de suivi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Clinical trials have not provided evidence for a role of statin therapy in reducing aortic valve stenosis (AVS) severity in patients with documented AVS. However, whether statin therapy could prevent the onset of AVS is unknown. Our objectives were (1) to compare the incidence rates of AVS among patients treated with high-dose versus usual-dose statin or placebo and (2) to identify clinical risk factors associated with the development of AVS. We conducted post hoc analyses in 23,508 participants from 3 large-scale multicenter atorvastatin randomized blinded clinical trials: Treating to New Targets, the Incremental Decrease in End Points Through Aggressive Lipid Lowering, and the Stroke Prevention by Aggressive Reduction in Cholesterol Levels. The main outcome measure was the incidence of clinical AVS over a median follow-up of 4.9 years (82 cases). Among patients who developed AVS, 39 (47.6%) were treated with atorvastatin 80 mg and 43 (52.4%) were treated with lower dose statin (atorvastatin 10 mg in Treating to New Targets, simvastatin 20 to 40 mg in Incremental Decrease in End Points Through Aggressive Lipid Lowering, or placebo in Stroke Prevention by Aggressive Reduction in Cholesterol Levels; hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.59 to 1.41, p=0.67). In multivariate analyses forcing treatment, sex, and race into the model, factors that were significantly associated with AVS included age (HR 2.17, 95% CI 1.61 to 2.93, p<0.0001 per 1-SD increment), diabetes (HR 1.67, 95% CI 1.00 to 2.80, p=0.05), vitamin K antagonist use (HR 3.25, 95% CI 2.06 to 5.16, p<0.0001), and previous statin use (HR 2.65, 95% CI 1.54 to 4.60, p=0.0008). In conclusion, random allocation to high-dose versus usual-dose statin therapy or placebo did not impact the incidence of AVS among patients without known AVS. Age, diabetes, vitamin K antagonists, and previous statin use were significant predictors of incident AVS in these high-risk patients.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>France</li><li>Norvège</li><li>Pays-Bas</li><li>États-Unis</li></country><region><li>Californie</li><li>Hollande-Septentrionale</li><li>Massachusetts</li><li>Nouvelle-Galles du Sud</li><li>Québec</li><li>État de New York</li><li>Île-de-France</li><li>Østlandet</li></region><settlement><li>Amsterdam</li><li>Montréal</li><li>Oslo</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université d'Amsterdam</li></orgName></list><tree><country name="Canada"><region name="Québec"><name sortKey="Arsenault, Benoit J" sort="Arsenault, Benoit J" uniqKey="Arsenault B" first="Benoit J" last="Arsenault">Benoit J. Arsenault</name></region><name sortKey="Tardif, Jean Claude" sort="Tardif, Jean Claude" uniqKey="Tardif J" first="Jean-Claude" last="Tardif">Jean-Claude Tardif</name></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Boekholdt, S Matthijs" sort="Boekholdt, S Matthijs" uniqKey="Boekholdt S" first="S Matthijs" last="Boekholdt">S Matthijs Boekholdt</name></region></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Mora, Samia" sort="Mora, Samia" uniqKey="Mora S" first="Samia" last="Mora">Samia Mora</name></region><name sortKey="Bao, Weihang" sort="Bao, Weihang" uniqKey="Bao W" first="Weihang" last="Bao">Weihang Bao</name><name sortKey="Demicco, David A" sort="Demicco, David A" uniqKey="Demicco D" first="David A" last="Demicco">David A. Demicco</name><name sortKey="Waters, David D" sort="Waters, David D" uniqKey="Waters D" first="David D" last="Waters">David D. Waters</name></country><country name="France"><region name="Île-de-France"><name sortKey="Amarenco, Pierre" sort="Amarenco, Pierre" uniqKey="Amarenco P" first="Pierre" last="Amarenco">Pierre Amarenco</name></region></country><country name="Norvège"><region name="Østlandet"><name sortKey="Pedersen, Terje" sort="Pedersen, Terje" uniqKey="Pedersen T" first="Terje" last="Pedersen">Terje Pedersen</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Barter, Philip" sort="Barter, Philip" uniqKey="Barter P" first="Philip" last="Barter">Philip Barter</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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