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STATIN USE AND ANEURYSM RISK IN PATIENTS WITH BICUSPID AORTIC VALVE DISEASE
A492 JACC April 1, 2014 Volume 63, Issue 12
Congenital Heart Disease Statin Use and Aneurysm Risk in Patients with Bicuspid Aortic Valve Disease Oral Contributions Room 146 A Saturday, March 29, 2014, 9:00 a.m.-9:15 a.m.
Session Title: Adult Congenital Heart Disease Abstract Category: 9. Congenital Heart Disease: Adult Presentation Number: 903-07 Authors: Alexander Perry Taylor, Patrick McCarthy, Adin-Cristian Andrei, Zhi (Carrie) Li, Edwin McGee, S. Chris Malaisrie, Colleen Clennon, Jyothy Puthumana, Northwestern University, Chicago, IL, USA Background: More than 50% of patients with bicuspid aortic valve (BAV) develop aortic dilatation, placing them at an 8-12 fold increased risk of aortic dissection compared to the general population and thereby warranting prophylactic aortic surgery. Previous studies have indicated that statin therapy might be associated with limited ascending aortic dilatation and aneurysm formation in BAV patients. We seek to determine the association between preoperative statin use and aortic dilatation among BAV patients referred for surgery. Methods: We included all patients with BAV who underwent aortic valve +/- aortic surgery between April 2004 to December 31 2012 at our center. Use of statins and antihypertensive medications, and history of aortic stenosis or insufficiency was captured in our registry. In BAV patients undergoing aortic valve replacement, current ACC/AHA guidelines state that aneurysm repair is indicated if the ascending aorta exceeds 4.5 cm. Based on the aortic diameter (AD) defined as the maximum aortic dimension on either echo, CT or MRI, patients were divided into two groups: AD < 4.5 cm or ≥ 4.5 cm. The association between preoperative statin use and aortic dilatation was assessed using logistic regression modeling with stepwise variable selection. Results: Our study included 565 patients, of whom 326 (58%) had AD < 4.5 cm (mean age 59 14 years, 70% male, 43% on statins), while 239 (42%) had AD ≥ 4.5 cm (mean age 54 13 years, 84% male, 26% on statins) at the time of surgery. After adjusting for preoperative body surface area, beta blocker use, diuretic use and aortic stenosis, patients with AD ≥ 4.5 cm had 0.51 times lower odds (95% CI 0.34 - 0.75) of being on preoperative statins compared to those with AD < 4.5 cm (p=0.001). Conclusions: In BAV patients who are referred for surgery, preoperative statin use is associated with a lower odds of ascending aortic dilatation. While further studies are needed to clarify the role of statins in BAV disease, our findings are intriguing and suggest that statins may play a protective role by limiting aortic dilatation in patients with BAV.
Congenital Heart Disease Statin Use and Aneurysm Risk in Patients with Bicuspid Aortic Valve Disease Oral Contributions Room 146 A Saturday, March 29, 2014, 9:00 a.m.-9:15 a.m.
Session Title: Adult Congenital Heart Disease Abstract Category: 9. Congenital Heart Disease: Adult Presentation Number: 903-07 Authors: Alexander Perry Taylor, Patrick McCarthy, Adin-Cristian Andrei, Zhi (Carrie) Li, Edwin McGee, S. Chris Malaisrie, Colleen Clennon, Jyothy Puthumana, Northwestern University, Chicago, IL, USA Background: More than 50% of patients with bicuspid aortic valve (BAV) develop aortic dilatation, placing them at an 8-12 fold increased risk of aortic dissection compared to the general population and thereby warranting prophylactic aortic surgery. Previous studies have indicated that statin therapy might be associated with limited ascending aortic dilatation and aneurysm formation in BAV patients. We seek to determine the association between preoperative statin use and aortic dilatation among BAV patients referred for surgery. Methods: We included all patients with BAV who underwent aortic valve +/- aortic surgery between April 2004 to December 31 2012 at our center. Use of statins and antihypertensive medications, and history of aortic stenosis or insufficiency was captured in our registry. In BAV patients undergoing aortic valve replacement, current ACC/AHA guidelines state that aneurysm repair is indicated if the ascending aorta exceeds 4.5 cm. Based on the aortic diameter (AD) defined as the maximum aortic dimension on either echo, CT or MRI, patients were divided into two groups: AD < 4.5 cm or ≥ 4.5 cm. The association between preoperative statin use and aortic dilatation was assessed using logistic regression modeling with stepwise variable selection. Results: Our study included 565 patients, of whom 326 (58%) had AD < 4.5 cm (mean age 59 14 years, 70% male, 43% on statins), while 239 (42%) had AD ≥ 4.5 cm (mean age 54 13 years, 84% male, 26% on statins) at the time of surgery. After adjusting for preoperative body surface area, beta blocker use, diuretic use and aortic stenosis, patients with AD ≥ 4.5 cm had 0.51 times lower odds (95% CI 0.34 - 0.75) of being on preoperative statins compared to those with AD < 4.5 cm (p=0.001). Conclusions: In BAV patients who are referred for surgery, preoperative statin use is associated with a lower odds of ascending aortic dilatation. While further studies are needed to clarify the role of statins in BAV disease, our findings are intriguing and suggest that statins may play a protective role by limiting aortic dilatation in patients with BAV.