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Neanche la rosuvastatina ha effetti sulla stenosi aortica

Nello sviluppo della stenosi aortica sono coinvolti molti degli eventi tipici dell'aterosclerosi, come la deposizione e l'ossidazione di lipidi, l'infiammazione, la fibrosi e, da ultimo, la calcificazione. E' quindi del tutto plausibile il tentativo di arrestare la progressione della stenosi aortica con gli stessi mezzi che hanno avuto successo nel modificare l'evoluzione dell'aterosclerosi. I risultati di questo studio, condotto con rosuvastatina 40 mg sono stati però negativi e confermano quanto era stato precedentemente rilevato in altri studi con atorvastatina (SALTIRE) o con l'associazione simvastatina-ezetimibe (SEAS). La terapia ipocolesterolemizzante non trova dunque indicazione nella prevenzione della stenosi aortica.

Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial.

Chan KL, Teo K, Dumesnil JG, Ni A, Tam J; ASTRONOMER Investigators.

Circulation 2010;121:306-314

BACKGROUND: Aortic stenosis (AS) is an active process with similarities to atherosclerosis. The objective of this study was to assess the effect of cholesterol lowering with rosuvastatin on the progression of AS. METHODS AND RESULTS: This was a randomized, double-blind, placebo-controlled trial in asymptomatic patients with mild to moderate AS and no clinical indications for cholesterol lowering. The patients were randomized to receive either placebo or rosuvastatin 40 mg daily. A total of 269 patients were randomized: 134 patients to rosuvastatin 40 mg daily and 135 patients to placebo. Annual echocardiograms were performed to assess AS progression, which was the primary outcome; the median follow-up was 3.5 years. The peak AS gradient increased in patients receiving rosuvastatin from a baseline of 40.8+/-11.1 to 57.8+/-22.7 mm Hg at the end of follow-up and in patients with placebo from 41.6+/-10.9 mm Hg at baseline to 54.8+/-19.8 mm Hg at the end of follow-up. The annualized increase in the peak AS gradient was 6.3+/-6.9 mm Hg in the rosuvastatin group and 6.1+/-8.2 mm Hg in the placebo group (P=0.83). Treatment with rosuvastatin was not associated with a reduction in AS progression in any of the predefined subgroups. CONCLUSIONS: Cholesterol lowering with rosuvastatin 40 mg did not reduce the progression of AS in patients with mild to moderate AS; thus, statins should not be used for the sole purpose of reducing the progression of AS. Clinical Trial Registration Information- URL: http://www.controlled-trials.com/. Clinical trial registration number: ISRCTN 32424163.

Circulation 2010;121:306-314