Comparison of ascending aortic size in patients with severe bicuspid aortic valve stenosis treated with versus without a statin drug

Abstract

Ascending aortic dilation commonly occurs in patients with bicuspid aortic valve (BAV). Statins have been shown to reduce the expression of matrix metalloproteinases and slow the progression of abdominal aortic aneurysms. The role of statins in slowing ascending aortic dilation in patients with BAV is unknown. We sought to compare the ascending aortic dimensions in patients with BAV stenosis treated with versus without a statin. From our catheterization laboratory database, all patients undergoing preoperative coronary angiography before aortic valve with or without ascending aorta replacement for bicuspid aortic stenosis (AS) from 2004 to 2007 were identified. The ascending aortic size was measured on their preoperative transesophageal echocardiogram. Data on statin use were obtained from chart review, and the ascending aortic size was compared between patients taking and not taking a statin. The study sample included 147 patients, of whom 76 were treated with statins (mean age 62 ± 9 years, 72% men) and 71 were not (mean age 59 ± 12 years, 68% men). The total and low-density lipoprotein cholesterol and triglyceride levels were significantly lower in the statin group. The ascending aorta size was significantly lower in the statin subgroup of the pure severe AS group (3.6 ± 0.7 cm vs 3.9 ± 0.6 cm, p < 0.01) but not in the mixed severe AS and severe aortic regurgitation group. In the pure severe AS group, significantly fewer patients taking a statin had an ascending aorta ≥ 4 cm (29% vs 52%, p < 0.02). On multivariate analysis, statin use was the only independent predictor of aortic size and was associated with a 0.33-cm reduction in aortic size (95% confidence interval 0.06 to 0.59, p < 0.01). In conclusion, patients with statin-treated BAV stenosis have a smaller ascending aortic size than patients with BAV untreated with statins.