Statins for aortic valve stenosis

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dc.contributor.authorThiago, Luciana
dc.contributor.authorTsuji, Selma Rumiko
dc.contributor.authorNyong, Jonathan
dc.contributor.authorPuga, Maria Eduarda dos Santos [UNIFESP]
dc.contributor.authorGois, Aecio Flavio Teixeira de [UNIFESP]
dc.contributor.authorMacedo, Cristiane Rufino de [UNIFESP]
dc.contributor.authorValente, Orsine [UNIFESP]
dc.contributor.authorAtallah, Álvaro Nagib [UNIFESP]
dc.date.accessioned2019-01-21T10:29:41Z
dc.date.available2019-01-21T10:29:41Z
dc.date.issued2016
dc.description.abstractBackground Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. Objectives To evaluate the effectiveness and safety of statins in aortic valve stenosis. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS ‐ IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria Randomised controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalisation for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. Main results We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low‐quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) ‐0.54, 95% confidence interval (CI) ‐1.88 to 0.80; participants = 1935; studies = 2), valve area (MD ‐0.07, 95% CI ‐0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD ‐0.06, 95% CI ‐0.26 to 0.14; participants = 155; study = 1). Moderate‐quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate‐quality evidence). Low‐ and very low‐quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low‐quality evidence) and hospitalisation for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low‐quality evidence). None of the four included studies reported on overall mortality and patient quality of life. Authors' conclusions Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis.The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.en
dc.description.affiliationDepartment of Education in Health Sciences,Marilia Medical School, Marilia, Brazil
dc.description.affiliationDepartment of Psychiatry and Evidence Based
dc.description.affiliationHealth Actions, Marilia Medical School, Marilia, Brazil
dc.description.affiliationInstitute of Health Informatics, University College London, London, UK.
dc.description.affiliationBrazilian Cochrane Centre, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
dc.description.affiliationBrazilian Cochrane Centre, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 598, BR-04039001 Sao Paulo, Brazil
dc.description.affiliationUnifespBrazilian Cochrane Centre, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 598, BR-04039001 Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipBrazilian Cochrane Centre, Federal University of Sao Paulo and Marilia Medical, Brazil
dc.format.extentCD009571
dc.identifierhttps://dx.doi.org/10.1002/14651858.CD009571.pub2
dc.identifier.citationCochrane Database Of Systematic Reviews. Hoboken, n. 9, p. CD009571, 2016.
dc.identifier.doi10.1002/14651858.CD009571.pub2
dc.identifier.fileWOS000389598700034.pdf
dc.identifier.issn1469-493X
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/49327
dc.identifier.wosWOS:000389598700034
dc.language.isoeng
dc.publisherInst Oceanografico, Univ Sao Paulo
dc.relation.ispartofCochrane Database Of Systematic Reviews
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectSystematic Reviewsen
dc.subjectProgressionen
dc.subjectTrialen
dc.subjectRosuvastatinen
dc.subjectTherapyen
dc.subjectMetaanalysesen
dc.subjectDiseaseen
dc.titleStatins for aortic valve stenosisen
dc.typeinfo:eu-repo/semantics/review
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