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Title: Aortic Valvular Disease in Elderly Subjects with Heterozygous Familial Hypercholesterolemia: Impact of Lipid-Lowering Therapy.
Author: Marco Benedi, Victoria
Laclaustra, Martin
Casado Domínguez, Juan M.
Villa Pobo, Rosa
Mateo Gallego, Rocío
Sánchez Hernández, Rosa M.
Blanco Nuez, Marta
Ortega Martínez de Victoria, Emilio
Sitges Carreño, Marta
Pedro Botet, Juan
Puzo, José
Villarroel, Teresa
Civeira, Fernando
Keywords: Vàlvules cardíaques
Malalties del cor
Genètica mèdica
Heart valves
Heart diseases
Medical genetics
Issue Date: 14-Dec-2019
Publisher: MDPI
Abstract: Hypercholesterolemia and statins are risk factors for aortic stenosis (AS) and vascular calcification, respectively. Whether heterozygous subjects with familial hypercholesterolemia (HeFH) treated with statins are at risk of AS is unknown. We study the prevalence of AS, aortic valve calcification (AoVC), and aortic sclerosis (ASc) in elderly subjects with HeFH in a prolonged statin treatment. Case-control study, cases were adults ≥65 years of age with a genetic diagnosis of HeFH, LDLc >220 mg/dl, and statin treatment ≥5 years. Controls were relatives of HeFH patients, with LDLc <190 mg/dl. Participants underwent a cardiac ultrasound for aortic valve analysis. We studied 205 subjects, 112 HeFH and 93 controls, with mean age 71.8(6.5) years and 70.0(7.3) years, respectively. HeHF, with respect to controls, presented greater gradients of aortic transvalvular pressure, 7.4(7.3) mmHg versus 5.0(2.8) mmHg, and maximum aortic velocity, 1.7(0.7) m/s versus 1.5(0.4) m/s, and lower aortic valve opening area, 2.0(0.7) cm2 versus 2.4(0.6) cm2 (all p < 0.05). AoVC and ASc were also more prevalent in HeFH (p < 0.05 between groups). Moderate/severe AS prevalence was higher among HeFH: 7.1% versus 1.1% (age- and sex-adjusted odds ratio (OR) 8.33, p = 0.03). Independent risk factors for aortic valve disease in HeFH were age and LDLc before treatment. The number of years under statin treatment was not associated with any aortic valve measurement. Subjects ≥65 years with HeFH in prolonged statin treatment show more aortic valvular disease and higher frequency of AS than controls. Life-long elevated LDLc exposure, rather than time of exposure to statins, explains this higher risk.
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It is part of: Journal of Clinical Medicine, 2019, vol. 8, num. 12
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ISSN: 2077-0383
Appears in Collections:Articles publicats en revistes (Medicina)

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