Clinical determinants of incident aortic valve stenosis in patients treated with atorvastatin: results from three large randomized clinical trials
Bibliographic record
Abstract
Background: Aortic valve stenosis (AVS) is the most common valvular heart disease in the Western world, and may share some risk factors with coronary heart disease (CHD). Clinical trials have failed to show a benefit for statin therapy in delaying the progression of AVS among asymptomatic individuals with known AVS. Whether statin therapy may decrease the incidence of AVS in populations enriched with CHD risk factors is unknown. Our objective was to compare the incidence rates of AVS among patients treated with high- versus low-dose statin or placebo and to identify clinical risk factors associated with the risk of AVS. Methods and results: Results from three large-scale atorvastatin trials were included in this study, the Treating to New Targets (TNT) trial, in which 80 mg and 10 mg/day of atorvastatin were compared in patients with stable coronary disease, the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) trial, in which atorvastatin 80 mg was compared to simvastatin 20 mg/day in post-myocardial infarction patients, and the Stroke Prevention by Aggressive Reduction in Cholesterol levels (SPARCL) trial, in which 80 mg/day of atorvastatin was compared to placebo in patients with a recent stroke or transient ischemic attack. All patients with known AVS at baseline were excluded from this analysis. During the follow-up (median=4.9 years), 45 patients developed AVS in TNT, 28 in IDEAL and 9 in SPARCL. Among the 82 patients who developed AVS, 39 (47.6%) patients were treated with atorvastatin 80 mg and 43 (52.4%) were treated with low-dose statin or placebo (hazard ratio [HR]=0.91 [95% CI, 0.59-1.41], p=0.67). Risk factors that showed a significant association in univariate regression analyses were entered into a multivariate model. These risk factors included age, height, weight, body mass index, diabetes, angina, previous coronary artery bypass grafting, peripheral vascular disease, warfarin and antiplatelets use, prior use of statins and calcium channel blockers use. In multivariate analyses forcing treatment, sex and race into the model, age (hazard ratio [HR]=2.24 [95% CI, 1.66-3.02], p<0.0001 per 1-SD increment), diabetes (HR=1.69 [1.00-2.82], p=0.05), warfarin and antiplatelets use (HR=2.89 [1.80-4.62], p<0.0001) and prior statin use (HR=2.56 [1.48-4.44], p=0.03) were significantly associated with the onset of AVS. Conclusions: In this study, high-dose statin therapy did not impact the incidence of AVS. We found that age, diabetes, warfarin and antiplatelets use and prior use of statins were significant predictors of incident AVS in these high-risk patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.009 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".