Elsevier

American Heart Journal

Volume 161, Issue 6, June 2011, Pages 1133-1139
American Heart Journal

Clinical Investigation
Valvular and Congenital Heart Disease
Effect of rosuvastatin on C-reactive protein and progression of aortic stenosis

https://doi.org/10.1016/j.ahj.2011.03.016Get rights and content

Background

Elevated C-reactive protein (CRP) is a common finding in patients with aortic stenosis (AS) and may be associated with rapid AS progression and worse outcome. The purpose of the study was to examine the role of high-sensitivity CRP and its interaction with rosuvastatin on the progression of AS.

Methods

We measured CRP at baseline, 1 year, and end of follow-up in 260 patients with a median follow-up of 3.5 years. Analyses were performed based on baseline CRP tertiles and baseline CRP >3 and ≤3 mg/L.

Results

After adjustment for baseline characteristics, higher CRP levels were associated with age, female gender, body mass index, and lower high-density lipoprotein cholesterol levels but not with AS severity. Treatment with rosuvastatin led to a persistent decrease in CRP at 1 year and end of follow-up. Progression of AS was detected in patients in all 3 CRP tertiles, and rosuvastatin treatment had no impact on progression in all 3 tertiles. Similar findings were observed using CRP >3 mg/L as the cutpoint. Multiple linear regression showed that baseline AS velocity (P < .001), but not CRP, was the only predictor of progression of AS; age (P = .05) and baseline AS velocity (P < .001), but not CRP and rosuvastatin treatment, were predictors of outcome events.

Conclusion

C-reactive protein does not predict severity, progression, and prognosis in patients with mild to moderate AS. Treatment with rosuvastatin reduces CRP levels but has no effect on the progression and clinical events of AS.

Section snippets

Study population

The ASTRONOMER trial was a multicenter, randomized, placebo-controlled, double-blind study that assessed the effect of intensive lipid lowering using rosuvastatin 40 mg daily on the progression of AS in patients with mild to moderate AS (peak velocity 2.5-4.0 m/s). Patients with any clinical indications for lipid lowering therapy were excluded from the trial. The trial design, baseline patient characteristics, and main results of the trial have been previously described.19, 20 In brief, 269

Baseline characteristics

The clinical characteristics and biochemical measurements of the 260 patients divided into the 3 CRP tertiles are shown in Table I, and the echocardiographic findings, in Table II. Multiple regression showed that age, female gender, BMI, and low high-density lipoprotein (HDL) cholesterol were associated with elevated CRP measurements (Table III). On the other hand, there was no significant relationship between severity of AS and baseline CRP levels (Figure 1). Aortic valve morphology (bicuspid

Discussion

C-reactive protein is an inflammatory biomarker that has been shown to provide incremental predictive value in determining future cardiac events independent of conventional atherosclerotic risk factors.8, 9, 10 The recently published JUPITER study showed that treatment of apparently healthy individuals without hyperlipidemia but with elevated CRP (≥2 mg/L) can reduce cardiovascular events.23 The inflammatory process has been shown to be operative in the development of AS.3, 4, 5, 6, 7

References (31)

  • R.B. Devereux et al.

    Echocardiography assessment of left ventricular hypertrophy: comparison to necropsy findings

    Am J Cardiol

    (1986)
  • A.m. Wilson et al.

    Widespread vascular production of C-reactive protein (CRP) and a relationship between serum CRP, plaque CRP, and intimal hypertrophy

    Atherosclerosis

    (2007)
  • G.M. Novaro et al.

    Clinical factors, but not C-reactive protein, predict progression of calcific aortic-valve disease: the Cardiovascular Health Study

    J Am Coll Cardiol

    (2007)
  • P.H. Stone

    C-reactive protein to identify early risk for development of calcific aortic stenosis

    J Am Coll Cardiol

    (2007)
  • C. Otto et al.

    Characterization of the early lesion of “degenerative” valvular aortic stenosis: histological and immunohistochemical studies

    Circulation

    (1994)
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