Aortic sclerosis medical therapy: Difference between revisions
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*Furthermore, the '''''SEAS''''' study also demonstrated no significant reduction in the composite outcome of combined aortic-valve events and ischemic events in patients who received aggressive lipid lowering therapy with [[simvastatin]] and [[ezetimibe]].<ref name="pmid18765433">{{cite journal |author=Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Bärwolf C, Holme I, Kesäniemi YA, Malbecq W, Nienaber CA, Ray S, Skjaerpe T, Wachtell K, Willenheimer R |title=Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis |journal=[[The New England Journal of Medicine]] |volume=359 |issue=13 |pages=1343–56 |year=2008 |month=September |pmid=18765433 |doi=10.1056/NEJMoa0804602 |url=http://dx.doi.org/10.1056/NEJMoa0804602 |accessdate=2012-04-10}}</ref> | *Furthermore, the '''''SEAS''''' study also demonstrated no significant reduction in the composite outcome of combined aortic-valve events and ischemic events in patients who received aggressive lipid lowering therapy with [[simvastatin]] and [[ezetimibe]].<ref name="pmid18765433">{{cite journal |author=Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Bärwolf C, Holme I, Kesäniemi YA, Malbecq W, Nienaber CA, Ray S, Skjaerpe T, Wachtell K, Willenheimer R |title=Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis |journal=[[The New England Journal of Medicine]] |volume=359 |issue=13 |pages=1343–56 |year=2008 |month=September |pmid=18765433 |doi=10.1056/NEJMoa0804602 |url=http://dx.doi.org/10.1056/NEJMoa0804602 |accessdate=2012-04-10}}</ref> | ||
==Antithrombotic Therapy== | |||
Patients with isolated aortic valve disease rarely experience embolic events, hence no antithrombotic therapy is required for the prevention of calcific microemboli. | |||
===2008 ACCP Guidelines Recommendation <ref name="pmid18574274">{{cite journal |author=Salem DN, O'Gara PT, Madias C, Pauker SG |title=Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=[[Chest]] |volume=133 |issue=6 Suppl |pages=593S–629S |year=2008 |month=June |pmid=18574274 |doi=10.1378/chest.08-0724 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574274 |accessdate=2012-04-10}}</ref>=== | |||
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====[[ACCP guidelines classification scheme#Grading Scheme Classification|Grade 2]]==== | |||
'''1.''' In patients with isolated calcific aortic valve disease who have not had [[ischemic stroke]] or [[transient ischemic attack]], we suggest against antithrombotic therapy. ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |||
'''2.''' In patients with isolated calcific aortic valve disease who have had [[ischemic stroke]] or [[transient ischemic attack]] not attributable to another source, we suggest [[aspirin]] (50 to 100 mg/d). ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}} | |||
==Endocarditis Prophylaxis== | |||
*According to the 2008 ACC/AHA guidelines,<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2012-04-10}}</ref> '''''no antibiotic prophylaxis''''' is recommended for patients with [[aortic sclerosis]]. | |||
==Guidelines Resources== | |||
*[http://chestjournal.chestpubs.org/content/133/6_suppl/593S.long#sec-1 Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)]<ref name="pmid18574274">{{cite journal |author=Salem DN, O'Gara PT, Madias C, Pauker SG |title=Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=[[Chest]] |volume=133 |issue=6 Suppl |pages=593S–629S |year=2008 |month=June |pmid=18574274 |doi=10.1378/chest.08-0724 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574274 |accessdate=2012-04-10}}</ref> | |||
*[http://circ.ahajournals.org/content/118/15/e523.full.pdf 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons]<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2012-04-10}}</ref> | |||
==References== | ==References== | ||
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[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 20:19, 10 April 2019
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Aortic sclerosisMicrochapters |
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Treatment |
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Case Studies |
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Aortic sclerosis medical therapy On the Web |
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American Roentgen Ray Society Images of Aortic sclerosis medical therapy |
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Risk calculators and risk factors for Aortic sclerosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Aortic sclerosis is non-obstructive degeneration of the aortic valve that presents predominantly in patients over 65 years of age who have risk factors for coronary artery disease. Because aortic sclerosis is associated with coronary artery disease risk factors, it is also associated with a significant increase in the risk of cardiovascular death, myocardial infarction even in the absence of hemodynamically significant left ventricular outflow tract obstruction.[1][2][3] Therefore, despite normal trans-valvular hemodynamic parameters, management of patients with aortic sclerosis is required.
Risk Factor Modification
- Aortic sclerosis has been suggested as a marker of increased cardiovascular risk, including increased mortality.[4][5] Therefore, risk factor reduction among this patient population is reasonable although no definitive study has demonstrated reduction in aortic sclerosis progression achieved with aggressive management of hypertension and dyslipidemia
- Both the SALTRIE[6] and the ASTRONOMER[7] trials failed to demonstrate any reduction in disease progression, with addition of statins in patients with mild to moderate calcific aortic stenosis.
- Furthermore, the SEAS study also demonstrated no significant reduction in the composite outcome of combined aortic-valve events and ischemic events in patients who received aggressive lipid lowering therapy with simvastatin and ezetimibe.[8]
Antithrombotic Therapy
Patients with isolated aortic valve disease rarely experience embolic events, hence no antithrombotic therapy is required for the prevention of calcific microemboli.
2008 ACCP Guidelines Recommendation [9]
| “ |
Grade 21. In patients with isolated calcific aortic valve disease who have not had ischemic stroke or transient ischemic attack, we suggest against antithrombotic therapy. (Level of Evidence: C) 2. In patients with isolated calcific aortic valve disease who have had ischemic stroke or transient ischemic attack not attributable to another source, we suggest aspirin (50 to 100 mg/d). (Level of Evidence: C) |
” |
Endocarditis Prophylaxis
- According to the 2008 ACC/AHA guidelines,[10] no antibiotic prophylaxis is recommended for patients with aortic sclerosis.
Guidelines Resources
- Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[9]
- 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons[10]
References
- ↑ Lindroos M, Kupari M, Heikkilä J, Tilvis R (1993). "Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample". Journal of the American College of Cardiology. 21 (5): 1220–5. PMID 8459080. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM (1997). "Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study". Journal of the American College of Cardiology. 29 (3): 630–4. PMID 9060903. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999). "Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly". The New England Journal of Medicine. 341 (3): 142–7. doi:10.1056/NEJM199907153410302. PMID 10403851. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Freeman RV, Otto CM (2005). "Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies". Circulation. 111 (24): 3316–26. doi:10.1161/CIRCULATIONAHA.104.486738. PMID 15967862. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Agmon Y, Khandheria BK, Meissner I, Sicks JR, O'Fallon WM, Wiebers DO, Whisnant JP, Seward JB, Tajik AJ (2001). "Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease? Insights from a population-based study". Journal of the American College of Cardiology. 38 (3): 827–34. PMID 11527641. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB, Boon NA (2005). "A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis". The New England Journal of Medicine. 352 (23): 2389–97. doi:10.1056/NEJMoa043876. PMID 15944423. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Chan KL, Teo K, Dumesnil JG, Ni A, Tam J (2010). "Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial". Circulation. 121 (2): 306–14. doi:10.1161/CIRCULATIONAHA.109.900027. PMID 20048204. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Bärwolf C, Holme I, Kesäniemi YA, Malbecq W, Nienaber CA, Ray S, Skjaerpe T, Wachtell K, Willenheimer R (2008). "Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis". The New England Journal of Medicine. 359 (13): 1343–56. doi:10.1056/NEJMoa0804602. PMID 18765433. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ 9.0 9.1 Salem DN, O'Gara PT, Madias C, Pauker SG (2008). "Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 593S–629S. doi:10.1378/chest.08-0724. PMID 18574274. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ 10.0 10.1 Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help)