Statin Therapy is not Associated with Improved Overall Survival after Transcatheter Aortic Valve Replacement (TAVR)

Abstract

HMG-CoA reductase inhibitors have been showed to be effective for primary and secondary prevention of cardiovascular and cerebrovascular events in a wide range of patients.1-3 High intensity statins appear to be of particular benefit in patients with established cardiovascular disease.4 However, whether or not the benefits of statin can be realized in patients with symptomatic aortic stenosis remains unclear. Previous studies have not established any a mortality benefit of statin in patients with noncorrected aortic stenosis.5 Conversely, patients undergoing surgical aortic valve replacement, there is evidence to suggest a mortality benefit after bioprosthetic valve replacement, which may be as high as a 42% reduction in mortality.6 More recently, advances in transcatheter aortic valve replacement (TAVR) has made surgical aortic valve replacement unnecessary for many non-low risk surgical candidates.7 This new era in the treatment of aortic stenosis has raised questions about the possible benefit of statin in this traditionally higher risk surgical group with aortic stenosis treated with the minimally invasive TAVR. Thus far, only one study on the effect on HMG-CoA reductase inhibitors on outcomes in patients after TAVR has been published. In 2017, Hudred et al. published a retrospective study of TAVR patients, which showed a high-intensity statin therapy was associated with a 64% reduction in all-cause mortality at 2 years.8 In this study, we attempt to reaffirm the findings of Hudred et al. and further define the mechanism by which statin therapy may confer a survival advantage post-TAVR.