Aortic stenosis medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 21: Line 21:
* Target [[blood pressure]] should be considered higher for patients with [[AS]]  than is recommended for the general [[population]].
* Target [[blood pressure]] should be considered higher for patients with [[AS]]  than is recommended for the general [[population]].
*Concurrent [[coronary artery disease]] is common in [[patients]] with [[AS]],  and screening of all [[patients]] is recommended for [[hypercholesterolemia]], for primary and [[secondary prevention]] of [[CAD]].
*Concurrent [[coronary artery disease]] is common in [[patients]] with [[AS]],  and screening of all [[patients]] is recommended for [[hypercholesterolemia]], for primary and [[secondary prevention]] of [[CAD]].
* In [[RCTs]] of [[statin]] therapy for mild to [[moderate AS]], the rate of [[ischemic]] events was reduced by about 20% in the statin therapy group. Howerer, [[aortic valve]] event rates were not reduced.
* In [[RCTs]] of [[statin]] therapy for mild to [[moderate AS]], the rate of [[ischemic]] events was reduced by about 20% in the statin therapy group. Howerer, [[aortic valve]] event rates were not reduced.<ref name="pmid18765433">{{cite journal |vauthors=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=N Engl J Med |volume=359 |issue=13 |pages=1343–56 |date=September 2008 |pmid=18765433 |doi=10.1056/NEJMoa0804602 |url=}}</ref>
*In [[patients]] undergoing [[TAVI]], treatment  with [[renin–angiotensin system]] blocker therapy after the procedure had a lower 1-year [[mortality rate]] than those not treated with [[renin–angiotensin system blocker therapy]], with a relative risk reduction of about 20% to 50% and an [[absolute risk reduction]] between 2.4% and 5.0%.
*In [[patients]] undergoing [[TAVI]], treatment  with [[renin–angiotensin system]] blocker therapy after the procedure had a lower 1-year [[mortality rate]] than those not treated with [[renin–angiotensin system blocker therapy]], with a relative risk reduction of about 20% to 50% and an [[absolute risk reduction]] between 2.4% and 5.0%.
* Use of [[renin–angiotensin system inhibitor]], was associated with a lower 1-year [[mortality rate]] among [[patients]] with [[preserved LVEF]] but not among those with [[reduced LVEF]].
* Use of [[renin–angiotensin system inhibitor]], was associated with a lower 1-year [[mortality rate]] among [[patients]] with [[preserved LVEF]] but not among those with [[reduced LVEF]].

Revision as of 13:18, 30 June 2022



Resident
Survival
Guide

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic stenosis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic stenosis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic stenosis medical therapy

CDC on Aortic stenosis medical therapy

Aortic stenosis medical therapy in the news

Blogs on Aortic stenosis medical therapy

Directions to Hospitals Treating Aortic stenosis medical therapy

Risk calculators and risk factors for Aortic stenosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Usama Talib, BSc, MD [4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]; Rim Halaby, M.D. [6]

Overview

Medical treatment of hypertension and hyperlipidemia according to the Guidelines is considered for patients with AS. Therapy with ACE inhibitor or ARB may reduce the mortality rate in patients with AS who underwent TAVI.

Medical Therapy

References

  1. Nazarzadeh M, Pinho-Gomes AC, Smith Byrne K, Canoy D, Raimondi F, Ayala Solares JR, Otto CM, Rahimi K (August 2019). "Systolic Blood Pressure and Risk of Valvular Heart Disease: A Mendelian Randomization Study". JAMA Cardiol. 4 (8): 788–795. doi:10.1001/jamacardio.2019.2202. PMC 6624812 Check |pmc= value (help). PMID 31290937.
  2. Nielsen OW, Sajadieh A, Sabbah M, Greve AM, Olsen MH, Boman K, Nienaber CA, Kesäniemi YA, Pedersen TR, Willenheimer R, Wachtell K (August 2016). "Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)". Circulation. 134 (6): 455–68. doi:10.1161/CIRCULATIONAHA.115.021213. PMID 27486164.
  3. Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D, Pibarot P (July 2005). "Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment". J Am Coll Cardiol. 46 (2): 291–8. doi:10.1016/j.jacc.2004.10.081. PMID 16022957.
  4. O'Brien KD, Zhao XQ, Shavelle DM, Caulfield MT, Letterer RA, Kapadia SR, Probstfield JL, Otto CM (April 2004). "Hemodynamic effects of the angiotensin-converting enzyme inhibitor, ramipril, in patients with mild to moderate aortic stenosis and preserved left ventricular function". J Investig Med. 52 (3): 185–91. doi:10.1136/jim-52-03-33. PMID 15222408.
  5. 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 (September 2008). "Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis". N Engl J Med. 359 (13): 1343–56. doi:10.1056/NEJMoa0804602. PMID 18765433.

Template:WH Template:WS CME Category::Cardiology