Metabolic syndrome an important predictor of progression of aortic stenosis

Metabolic syndrome an important predictor of progression of aortic stenosis

Metabolic syndrome has been documented as a powerful and independent predictor of more rapid progression of aortic stenosis, more so in the young in a prospective study by Romain et al, the ASTRONOMER Investigators [1]. This was a predefined sub study of ASTRONOMER trial and included 243 of the 269 patients enrolled in the parent study. Metabolic syndrome was present in 27% of them.

Mean follow up period was nearly three and a half years. Progression of aortic stenosis was assessed by the annual increase in the peak aortic velocity. Patients with metabolic syndrome had a faster progression with mean increase of peak aortic velocity of 25 centimeters per second per year compared to 19 centimeters per second per year, p = 0.03. The effect of metabolic syndrome on progression of aortic stenosis was more in those aged less than fifty seven years, p = 0.008.

There was an apparent progression in those with metabolic syndrome on statins, p = 0.045. But on multivariate analysis, metabolic syndrome-statin interaction was not significant. This aspect of apparent faster progression of aortic stenosis in normocholesterolemic patients with metabolic syndrome receiving statins needs to be checked in future larger studies. Authors noted that several randomized trials have not been able to show any significant effect of statins on the progression of aortic stenosis. Newer clinical trials targeting Lp(a) or PCSK9 have shown promising results in reducing the severity of aortic stenosis as per a review on the topic published in 2022 [2].

References

1. Romain Capoulade, Marie-Annick Clavel, Jean G Dumesnil, Kwan L Chan, Koon K Teo, James W Tam, Nancy Côté, Patrick Mathieu, Jean-Pierre Després, Philippe Pibarot, ASTRONOMER Investigators. Impact of Metabolic Syndrome on Progression of Aortic Stenosis. J Am Coll Cardiol. 2012 Jul 17;60(3):216-23.
2. Nsaibia MJ, Devendran A, Goubaa E, Bouitbir J, Capoulade R, Bouchareb R. Implication of Lipids in Calcified Aortic Valve Pathogenesis: Why Did Statins Fail? J Clin Med. 2022 Jun 10;11(12):3331. doi: 10.3390/jcm11123331. PMID: 35743402; PMCID: PMC9225514.