| 1. |
- Baranowska, Julia, et al.
(author)
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Associations between medical therapy after surgical aortic valve replacement for aortic stenosis and long-term mortality: a report from the SWEDEHEART registry.
- 2022
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In: European heart journal. Cardiovascular pharmacotherapy. - : Oxford University Press (OUP). - 2055-6837 .- 2055-6845. ; 8:8, s. 837-846
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Journal article (peer-reviewed)abstract
- The association between use of statins, renin-angiotensin system (RAS) inhibitors and/or β-blockers and long-term mortality in patients with aortic stenosis who underwent surgical aortic valve replacement (SAVR) is unknown.All patients with aortic stenosis who underwent isolated first time SAVR in Sweden from 2006 to 2017 and survived six months after discharge were included. Individual patient data from four mandatory nationwide registries were merged. Cox proportional hazards models, with time-updated data on medication status and adjusted for age, sex, comorbidities, type of prosthesis, and year of surgery, were used to investigate associations between dispensed statins, RAS inhibitors, and β-blockers, and all-cause mortality. In total, 9553 patients were included, and median follow-up time was 4.9 years (range 0-11); 1738 patients (18.2%) died during follow-up. Statins were dispensed to 49.1% and 49.0% of the patients within six months of discharge from hospital and after ten years, respectively. Corresponding figures were 51.4% and 53.9% for RAS inhibitors, and 79.3% and 60.7% for β-blockers. Ongoing treatment was associated with lower mortality risk for statins [adjusted hazard ratio (aHR) 0.67 (95% confidence interval 0.60-0.74), p<0.001] and RAS inhibitors [aHR 0.84 (0.76-0.93), p<0.001] but not for β-blockers [aHR 1.17 (1.05-1.30), p=0.004]. The associations were robust in subgroups based on age, sex, and comorbidities (p for interactions>0.05).The results of this large population-based real-world study support the use of statins and RAS inhibitors for patients who underwent SAVR due to aortic stenosis.
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| 2. |
- Martinsson, Andreas, et al.
(author)
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Renin-angiotensin system inhibition after surgical aortic valve replacement for aortic stenosis.
- 2024
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In: Heart (British Cardiac Society). - 1468-201X. ; 110:3, s. 202-208
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Journal article (peer-reviewed)abstract
- The optimal medical therapy after surgical aortic valve replacement (SAVR) for aortic stenosis remains unknown. Renin-angiotensin system (RAS) inhibitors could potentially improve cardiac remodelling and clinical outcomes after SAVR.All patients undergoing SAVR due to aortic stenosis in Sweden 2006-2020 and surviving 6 months after surgery were included. The primary outcome was major adverse cardiovascular events (MACEs; all-cause mortality, stroke or myocardial infarction). Secondary endpoints included the individual components of MACE and cardiovascular mortality. Time-updated adjusted Cox regression models were used to compare patients with and without RAS inhibitors. Subgroup analyses were performed, as well as a comparison between angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).A total of 11894 patients (mean age, 69.5 years, 40.4%women) were included. Median follow-up time was 5.4 (2.7-8.5) years. At baseline, 53.6% of patients were dispensed RAS inhibitors, this proportion remained stable during follow-up. RAS inhibition was associated with a lower risk of MACE (adjusted hazard ratio (aHR) 0.87 (95% CI 0.81 to 0.93), p<0.001), mainly driven by a lower risk of all-cause death (aHR 0.79 (0.73 to 0.86), p<0.001). The lower MACE risk was consistent in all subgroups except for those with mechanical prostheses (aHR 1.07 (0.84 to 1.37), p for interaction=0.040). Both treatment with ACE inhibitors (aHR 0.89 (95% CI 0.82 to 0.97)) and ARBs (0.87 (0.81 to 0.93)) were associated with lower risk of MACE.The results of this study suggest that medical therapy with an RAS inhibitor after SAVR is associated with a 13% lower risk of MACE and a 21% lower risk of all-cause death.
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| 3. |
- Pan, Emily, et al.
(author)
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Statin treatment after surgical aortic valve replacement for aortic stenosis is associated with better long-term outcome.
- 2024
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In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 1873-734X.
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Journal article (peer-reviewed)abstract
- To evaluate the association between statin use after surgical aortic valve replacement for aortic stenosis and long-term risk for major adverse cardiovascular events in a large population-based, nationwide cohort.All patients that underwent isolated surgical aortic valve replacement due to aortic stenosis in Sweden 2006-2020 and survived six months after discharge were included. Individual patient data from five nationwide registries were merged. Primary outcome is major adverse cardiovascular event (defined as all-cause mortality, myocardial infarction, or stroke). Multivariable Cox regression model adjusted for age, sex, comorbidities, valve type, operation year, and secondary prevention medications is used to evaluate the association between time-updated dispense of statins and long-term outcome in the entire study population, and in subgroups based on age, sex and comorbidities.A total of 11,894 patients were included. Statins were dispensed to 49.8% (5918/11894) of patients at baseline, and 51.0% (874/1713) after ten years. At baseline, 3.6% of patients were dispensed low dose, 69.4% medium dose and 27.0% high dose statins. After adjustments, ongoing statin treatment was associated with a reduced risk for major adverse cardiovascular event [adjusted hazard ratio 0.77 (95% confidence interval 0.71-0.83). p<0.001], mainly driven by a reduction in all-cause mortality [adjusted hazard ratio, 0.70 (0.64-0.76)], p<0.001. The results were consistent in all subgroups.The results suggest that statin therapy might be beneficial for patients undergoing surgical aortic valve replacement for aortic stenosis. Randomized controlled trials are warranted to establish causality between statin treatment and improved outcome.
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| 4. |
- Törngren, Charlotta, et al.
(author)
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Medical therapy after surgical aortic valve replacement for aortic regurgitation.
- 2023
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In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1873-734X. ; 63:5
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Journal article (peer-reviewed)abstract
- Current clinical guidelines have no specific recommendations regarding medical therapy after surgical aortic valve replacement in patients with aortic regurgitation. We studied the association between medical therapy with RAS inhibitors, statins and beta-blockers, and long-term major adverse cardiovascular events.All patients undergoing valve replacement due to aortic regurgitation between 2006-2017 in Sweden and alive six months after discharge were included. Time-dependent multivariable Cox regression models adjusted for age, sex, patient characteristics, comorbidities, other medications, and year of SAVR were used. Primary outcome was a composite of all-cause mortality, myocardial infarction, and stroke. Subgroup analyses based on age, sex, heart failure, low ejection fraction, hyperlipidaemia, and hypertension were performed.A total of 2,204 patients were included (median follow-up 5.0 years (range 0.0-11.5)). At baseline, 68% of the patients were dispensed RAS inhibitors, 80% beta-blockers, and 35% statins. Dispense of RAS inhibitors and beta-blockers declined over time, especially during the first year after baseline, while dispense of statins remained stable. Treatment with RAS inhibitors or statins was associated with a reduced risk of the primary outcome (aHR 0.71, 95%CI 0.57-0.87 and aHR 0.78, 95%CI 0.62-0.99, respectively). The results were consistent in subgroups based on age, sex, and comorbidities. Beta-blocker treatment was associated with an increased risk for the primary outcome (aHR 1.35, 95%CI 1.07-1.70).The results indicate a potential beneficial association of RAS inhibitors and statins as part of a secondary preventive treatment regime after aortic valve replacement in patients with aortic regurgitation. The role of beta-blockers needs to be further investigated.
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