SALTIRE–RAAVE: targeting calcific aortic valve disease LDL-density-radius theory

Abstract

SALTIRE and RAAVE were the first two studies to evaluate the use of statin therapy for impeding calcific aortic valve disease (CAVD). This review presents the findings of low-density lipoprotein (LDL)-density-radius theory as tested using the combined results from the SALTIRE and RAAVE studies. Patients who received statin therapy had a greater degree of LDL cholesterol lowering, seen as the % change in LDL (47 vs 2%, p = 0.012), which in itself was significantly associated with a lesser change in aortic valve area (AVA; p < 0.001 and R² = 0.27). The percent change in the AVA for the treated patients was 5% and 15% for the nontreated patients (p = 0.579 and R² = 0.03). In summary, these published findings suggest that when applying the LDL-density-radius theory, which combines the cellular biology and the hemodynamics as defined by the continuity equation for AVA, there may be a role for lipid-lowering therapy in contemporary patients with calcific aortic valve disease (CAVD).

Keywords:

• aortic valve stenosis
• atherosclerosis
• calcification
• clinical trials
• hemodynamics
• statins

Acknowledgements

N Rajamannan is an inventor for a patent for the use of statins in degeneration of aortic valve disease. The Mayo Clinic owns this patent and N Rajamannan does not receive any royalties from this patent.

Financial & competing interests disclosure

N Rajamannan is an inventor for a patent to treat aortic stenosis but does not receive royalties, the patent is owned by the Mayo Clinic, Rochester MN. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Cardiovascular risk factors are critical in the development of calcific aortic valve disease (CAVD).

• Understanding the lessons from the initial randomized studies in the field of calcific CAVD is critical in the design of clinical studies in this field.

• Noninvasive imaging is important in defining disease progression and determining the level of calcification in the valve leaflet.

• Future clinical trials in this field will need to take into account the severity of the disease and also the initiating factors to alleviate the progression in this patient population.

• The radius of the coronary artery is much smaller than the radius of the outflow tract of the aortic valve. The effect of the radius in the continuity equation and the use of echocardiography in the assessment of calcific aortic valve disease (CAVD) are critical for future design of clinical trials in this field.

Notes