JACC: Bisphosphonates do not slow progress of aortic stenosis

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structural heart - 43.09 Kb
Aortic stenosis is a narrowing of the aortic valve that limits the flow of blood from the left ventricle to the aorta. Surgical replacement of aortic valve pictured. Source: NYU Langone Medical Center

Bisphosphonates did not have a significant impact on the hemodynamic or clinical progression of aortic stenosis in a retrospective analysis of older female patients, published April 17 in the Journal of the American College of Cardiology. “The study also illustrates that the rate of progression of aortic stenosis in this population is not linear but tends to lessen over time,” the study authors wrote.

“Although several trials have evaluated the role of statins in altering the inflammatory process of the valve, calcification has not been clearly targeted,” the study authors wrote. “Bisphosphonates, drugs that are approved for use in patients with osteoporosis, have been shown to inhibit vascular calcification.” Thus, in this study, Olcay Aksoy, MD, and colleagues at the NYU Langone Medical Center sought to investigate the impact of bisphosphonates on the progression of aortic stenosis.

The researchers identified and retrospectively studied female patients older than the age of 60 years with an aortic valve area between 1 cm 2 and 2 cm 2. Only those who had follow-up echocardiograms at least a year apart were included. They established the primary outcomes of change in aortic valve area and valvular gradients over time. Mortality and freedom from aortic valve replacement also were evaluated. A propensity-matching method was applied for the probability of the use of bisphosphonates.

The researchers included 801 female patients (mean age, 76 years) with a mean follow-up of 5.1 years. The mean duration of bisphosphonate use was 3.1 years.

At the time of the initial echocardiogram, 38 percent were taking bisphosphonates. The mean ejection fraction at baseline was 56.7 percent with a mean aortic valve area of 1.32 cm 2. Peak and mean gradients were 28.4 mm Hg and 15.6 mm Hg, respectively. Propensity matching was successfully performed for 438 patients.

On follow-up, Aksoy et al reported that there were no differences in the rate of change in aortic valve area or peak and mean gradients when patients were stratified based on the use of bisphosphonates. Bisphosphonates also had no impact on survival or freedom from aortic valve replacement.

“Furthermore, the use of bisphosphonates did not affect the survival or the rate of aortic valve replacement during follow-up,” the study authors wrote.

The researchers added that the progression tends to slow after an early period of acceleration. They suggested that future studies of longer term progression of aortic stenosis should take into account the likelihood of a nonlinear change in both valve area and pressure gradients over time.