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 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 Citations (Scopus)

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
Externally publishedYes

Fingerprint

Rheumatic Heart Disease
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Rheumatic Diseases
Heart Valve Diseases
Hypercholesterolemia
Blood Vessels
Atherosclerosis
Retrospective Studies
Epidemiologic Factors
Therapeutics
Aortic Valve
Disease Progression
Epidemiologic Studies
Theoretical Models
Randomized Controlled Trials
Smoking
Clinical Trials
Prospective Studies
Hypertension
Serum

Keywords

  • Clinical trials
  • Lipids
  • Pathophysiology
  • Valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rajamannan, N. M., Antonini-Canterin, F., Moura, L., Zamorano, J. L., Rosenhek, R. A., Best, P., ... 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.

Medical therapy for rheumatic heart disease : Is it time to be proactive rather than reactive? / Rajamannan, Nalini M.; Antonini-Canterin, Francesco; Moura, Luis; Zamorano, José L.; Rosenhek, Raphael A.; Best, Patricia; Lloyd, Margaret A.; Rocha-Gonçalves, F.; Chandra, Sarat; Alfieri, Ottavio; Lancellotti, Patrizio; Tornos, Pilar; Baliga, Ragavendra R.; Wang, Andrew; Bashore, Thomas; Ramakrishnan, S.; Spargias, Konstantinos; Shuvy, Mony; Beeri, Ronen; Lotan, Chaim; Suwaidi, Jassim Al; Bahl, Vinay; Pierard, Luc A.; Maurer, Gerald; Nicolosi, Gian Luigi; Rahimtoola, Shahbudin H.; Chopra, H. K.; Pandian, Natesa G.

In: Indian Heart Journal, Vol. 61, No. 1, 01.01.2009, p. 14-23.

Research output: Contribution to journalReview article

Rajamannan, NM, Antonini-Canterin, F, Moura, L, Zamorano, JL, Rosenhek, RA, Best, P, Lloyd, MA, Rocha-Gonçalves, F, Chandra, S, Alfieri, O, Lancellotti, P, Tornos, P, Baliga, RR, Wang, A, Bashore, T, Ramakrishnan, S, Spargias, K, Shuvy, M, Beeri, R, Lotan, C, Suwaidi, JA, Bahl, V, Pierard, LA, Maurer, G, Nicolosi, GL, Rahimtoola, SH, Chopra, HK & Pandian, NG 2009, 'Medical therapy for rheumatic heart disease: Is it time to be proactive rather than reactive?', Indian Heart Journal, vol. 61, no. 1, pp. 14-23.
Rajamannan NM, Antonini-Canterin F, Moura L, Zamorano JL, Rosenhek RA, Best P et al. Medical therapy for rheumatic heart disease: Is it time to be proactive rather than reactive? Indian Heart Journal. 2009 Jan 1;61(1):14-23.
Rajamannan, Nalini M. ; Antonini-Canterin, Francesco ; Moura, Luis ; Zamorano, José L. ; Rosenhek, Raphael A. ; Best, Patricia ; Lloyd, Margaret A. ; Rocha-Gonçalves, F. ; Chandra, Sarat ; Alfieri, Ottavio ; Lancellotti, Patrizio ; Tornos, Pilar ; Baliga, Ragavendra R. ; Wang, Andrew ; Bashore, Thomas ; Ramakrishnan, S. ; Spargias, Konstantinos ; Shuvy, Mony ; Beeri, Ronen ; Lotan, Chaim ; Suwaidi, Jassim Al ; Bahl, Vinay ; Pierard, Luc A. ; Maurer, Gerald ; Nicolosi, Gian Luigi ; Rahimtoola, Shahbudin H. ; Chopra, H. K. ; Pandian, Natesa G. / Medical therapy for rheumatic heart disease : Is it time to be proactive rather than reactive?. In: Indian Heart Journal. 2009 ; Vol. 61, No. 1. pp. 14-23.
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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.",
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AU - Ramakrishnan, S.

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AU - Shuvy, Mony

AU - Beeri, Ronen

AU - Lotan, Chaim

AU - Suwaidi, Jassim Al

AU - Bahl, Vinay

AU - Pierard, Luc A.

AU - Maurer, Gerald

AU - Nicolosi, Gian Luigi

AU - Rahimtoola, Shahbudin H.

AU - Chopra, H. K.

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