Medical therapy for rheumatic heart disease: Is it time to be proactive rather than reactive?

Nalini M. Rajamannan, Francesco Antonini-Canterin, Luis Moura, José L. Zamorano, Raphael A. Rosenhek, Patricia J.M. Best, Margaret A. Lloyd, F. Rocha-Gonçalves, Sarat Chandra, Ottavio Alfieri, Patrizio Lancellotti, Pilar Tornos, Ragavendra R. Baliga, Andrew Wang, Thomas Bashore, S. Ramakrishnan, Konstantinos Spargias, Mony Shuvy, Ronen Beeri, Chaim LotanJassim Al Suwaidi, Vinay Bahl, Luc A. Pierard, Gerald Maurer, Gian Luigi Nicolosi, Shahbudin H. Rahimtoola, H. K. Chopra, Natesa G. Pandian

Research output: Contribution to journalReview article

14 Scopus citations

Abstract

Rheumatic Heart Disease (RHD) is well known to be an active inflammatory process which develops progressive calcification and leaflet thickening over time. The potential for statin therapy in slowing the progression of valvular heart disease is still controversial. Retrospective studies have shown that medical therapy is beneficial for patients with calcific aortic stenosis and recently for rheumatic valve disease. However, the prospective randomized clinical trials have been negative to date. This article discusses the epidemiologic risk factors, basic science, retrospective and prospective studies in valvular heart disease and a future clinical trial to target RHD with statin therapy to slow the progression of this disease. Recent epidemiological studies have revealed the risk factors associated with valvular disease include male gender, smoking, hypertension and elevated serum cholesterol and are similar to the risk factors for vascular atherosclerosis. An increasing number of models of experimental hypercholesterolemia demonstrate features of atherosclerosis in the aortic valve (AV), which are similar to the early stages of vascular atherosclerotic lesions. Calcification, the end stage process of the disease, must be understood as a prognostic indicator in the modification of this cellular process before it is too late. This is important in calcific aortic stenosis as well as in rheumatic valve disease. There are a growing number of studies that describe similar pathophysiologic molecular markers in the development of rheumatic valve disease as in calcific aortic stenosis. In summary, these findings suggest that medical therapies may have a potential role in patients in the early stages of this disease process to slow the progression of RHD affecting the valves. This review will summarize the potential for statin therapy for this patient population.

Original languageEnglish (US)
Pages (from-to)14-23
Number of pages10
JournalIndian heart journal
Volume61
Issue number1
StatePublished - Jan 1 2009

Keywords

  • Clinical trials
  • Lipids
  • Pathophysiology
  • Valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Rajamannan, N. M., Antonini-Canterin, F., Moura, L., Zamorano, J. L., Rosenhek, R. A., Best, P. J. M., Lloyd, M. A., Rocha-Gonçalves, F., Chandra, S., Alfieri, O., Lancellotti, P., Tornos, P., Baliga, R. R., Wang, A., Bashore, T., Ramakrishnan, S., Spargias, K., Shuvy, M., Beeri, R., ... Pandian, N. G. (2009). Medical therapy for rheumatic heart disease: Is it time to be proactive rather than reactive? Indian heart journal, 61(1), 14-23.