Intensive Lipid-Lowering Therapy for Patients With Aortic Stenosis†

It has been suggested by several retrospective studies that lipid-lowering therapy (compared with treatment with medications other than statins) retards the progression of aortic stenosis. Additional evidence for this has emerged from the prospective (nonrandomized) Rosuvastatin Affecting Aortic Valve Endothelium (RAAVE) study, although not from findings of the randomized, double-blind Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression (SALTIRE). Currently, 2 larger randomized studies of aortic stenosis are in progress. These studies have longer durations than SALTIRE. The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, with 1,873 patients, is the largest study with the longest planned length of treatment (4 to 7 years) that will assess whether lipid-lowering therapy slows the progression of aortic stenosis and the degradation of the aortic valve, thereby potentially reducing the urgency for surgery or at least delaying the need for surgery, relieving adverse hemodynamic consequences of aortic stenosis, and possibly decreasing mortality and morbidity in these patients. The Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin (ASTRONOMER) trial, a study of disease progression, involves 272 patients with aortic stenosis, with treatment arms of rosuvastatin 40 mg/d and placebo for 3 to 5 years. In conclusion, the SEAS and ASTRONOMER studies will help resolve the contradictory findings of SALTIRE and RAAVE on the benefit of intensive lipid-lowering treatment in aortic stenosis.