Risk Factors for Progression of Degenerative Aortic Valve Disease in the Japanese　– The Japanese Aortic Stenosis Study (JASS) Prospective Analysis –

Kazuhiro Yamamoto; Hideya Yamamoto; Masaaki Takeuchi; Akira Kisanuki; Takashi Akasaka; Nobuyuki Ohte; Yutaka Hirano; Kiyoshi Yoshida; Satoshi Nakatani; Yasuharu Takeda; Takashi Sozu; Tohru Masuyama

doi:10.1253/circj.CJ-15-0499

Valvular Heart Disease

Risk Factors for Progression of Degenerative Aortic Valve Disease in the Japanese　– The Japanese Aortic Stenosis Study (JASS) Prospective Analysis –

Kazuhiro Yamamoto, Hideya Yamamoto, Masaaki Takeuchi, Akira Kisanuki, Takashi Akasaka, Nobuyuki Ohte, Yutaka Hirano, Kiyoshi Yoshida, Satoshi Nakatani, Yasuharu Takeda, Takashi Sozu, Tohru Masuyama

Author information

Kazuhiro Yamamoto
Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Hideya Yamamoto
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
Masaaki Takeuchi
Department of Laboratory and Transfusion Medicine, School of Medicine, University of Occupational and Environmental Health
Akira Kisanuki
School of Health Sciences, Kagoshima University
Takashi Akasaka
Department of Cardiovascular Medicine, Wakayama Medical University
Nobuyuki Ohte
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences
Yutaka Hirano
Division of Central Clinical Laboratory, Kinki University Hospital
Kiyoshi Yoshida
Department of Cardiology, Kawasaki Medical School
Satoshi Nakatani
Department of Health Sciences, Division of Functional Diagnostics, Osaka University Graduate School of Medicine
Yasuharu Takeda
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
Takashi Sozu
Department of Management Science, Faculty of Engineering, Tokyo University of Science
Tohru Masuyama
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine

Keywords: Angiotensin-converting enzyme inhibitor, Angiotensin-receptor blocker, Aortic valve, Degeneration, Warfarin

JOURNAL FREE ACCESS FULL-TEXT HTML

2015 Volume 79 Issue 9 Pages 2050-2057

DOI https://doi.org/10.1253/circj.CJ-15-0499

Editorial (79-9 pp. 1908-1909)

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Abstract

Background:Because of ethnic difference in the risk of degenerative aortic valve disease (DAVD), risk factors should be clarified in each race to establish prophylactic strategies for severe aortic valve stenosis (AS).Methods and Results:This study prospectively followed 359 Japanese subjects with DAVD and age ≥50 years for 3 years. As both patients with peak aortic transvalvular flow velocity ≥2 m/s and <2 m/s were enrolled, subgroup analysis was also conducted. Most patients were under treatment for their comorbidities. The use of warfarin, but none of the traditional risk factors for atherosclerosis, was related to greater reduction in aortic valve area indexed to body surface area (iAVA). In patients with peak aortic transvalvular flow velocity <2 m/s, the use of an angiotensin-receptor blocker (ARB) was associated with less decrease in iAVA. In patients with peak velocity ≥2 m/s, changes in iAVA were not related to any baseline characteristics, but peak velocity was less increased under treatment with an angiotensin-converting enzyme inhibitor (ACEI).Conclusions:In Japanese, the use of warfarin may exacerbate DAVD, and augmented management of atherosclerotic risk factors beyond the recommendations in the current guidelines is unlikely to exert additional benefit. The prescription of ARB for DAVD patients before the development of AS or ACEI after the development of AS may be useful. (Circ J 2015; 79: 2050–2057)

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