To the Editor:
We welcome the comments and interest of Drs. Toganel, Benedek, and Chitu regarding our study. As the authors note, we reported that preoperative statin therapy was associated with decreased odds of ascending aortic dilatation in our cohort of surgical patients with bicuspid aortic valve (BAV) disease.1 With regard to a potential inverse association between coronary artery disease (CAD) and aortopathy, we performed sensitivity analyses in patients with and without CAD. Although not statistically significant, statin use was associated with lower odds of aortic dilatation (AD) defined as AD ≥4.5 cm in both groups (0.74 for AD ≥4.5 cm in CAD patients, 95% confidence interval [CI]: 0.29‐1.86, P = 0.515; odds ratio: 0.79 for AD ≥4.5 cm in non‐CAD patients, 95% CI: 0.51‐1.22, P = 0.284). Jackson and colleagues2 observed that ascending aortic dilatation is rarely associated with CAD. As we noted in our article, it is possible that atherosclerosis creates stiffer aortas that dilate less, or alternatively, BAV disease is comprised of heterogeneous phenotypes,3 and it is conceivable that BAV patients with CAD could have less severe aortic involvement. No matter the etiology, we agree that further prospective studies are needed to help clarify the relationship between CAD and aortic dilatation in BAV disease.
Regeer and colleagues4 found that the use of statins was associated with smaller ascending aortic dimensions, but the annual dilation rate of the aortic root was not influenced by statin use. However, this study included a very small number of patients on statins (n = 41), and CAD, advanced age, and other comorbidities were more prevalent in statin users compared to non–statin users. Also, the median 3.9‐year echocardiographic follow‐up of the statin users may have been too short to observe an effect of statin therapy on the rate of aortic root dilatation. Furthermore, other studies5, 6, 7 of patients with BAV disease or thoracic aortic aneurysms of other etiologies have found that statin users have less aortic dilatation compared to non–statin users. The weight of the existing evidence suggests that statin therapy likely reduces ascending aortic dilatation. A randomized controlled trial of statin therapy in patients with BAV disease is needed to define, in a more definitive way, the impact of statins on absolute aortic size and rate of aortic dilatation.
Ajay Yadlapati MD Alexander P. Taylor BA Neil J. Stone MD Robert O. Bonow MD Jyothy J. Puthumana MD Division of Cardiology Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine Chicago, Illinois
References
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