“Bad Cholesterol” LDL-C Linked to Aortic Valve Disease

George Thanassoulis, MD MSc FRCP(C) Director, Preventive and Genomic Cardiology FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien Assistant Professor of Medicine, McGill University McGill University Health Center Montreal, QCMedicalResearch.com Interview with:
George Thanassoulis, MD MSc FRCP(C)

Director, Preventive and Genomic Cardiology
FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien
Assistant Professor of Medicine, McGill University
McGill University Health Center Montreal, QC

Medical Research: What is the background for this study? What are the main findings?

Dr. Thanassoulis: Although LDL-C (i.e. bad cholesterol) has been linked with aortic valve disease in several prior reports, randomized trials to lower cholesterol in aortic valve disease were not effective suggesting that cholesterol may not be important in valve disease.

To address this, we performed a Mendelian randomization study, that showed that a genetic predisposition to LDL-C, was associated with both calcium deposits on the aortic valve and aortic stenosis (I.e. Valve narrowing).  These results can be viewed as the effect of a life-long increase in LDL-C on the incidence of aortic valve disease and suggest that increases in LDL-C cause aortic stenosis.  

Medical Research: What should clinicians and patients take away from your report?

Dr. Thanassoulis: Our results provide new evidence that LDL-c, in addition to the known risks of heart attack and stroke, also predispose to aortic valve disease.  Importantly, our research suggests that prior RCTs of cholesterol lowering likely failed because the intervention was performed too late in the disease process.  Earlier lowering of LDL-C prior to any significant valve disease may be required to prevent valve disease.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Thanassoulis: To confirm this hypothesis, new randomized trials with LDL-C lowering agents early in the disease process are needed.

Citation:
Gustav Smith, Kevin Luk, Christina-Alexandra Schulz, James C. Engert, Ron Do, George Hindy, Gull Rukh, Line Dufresne, Peter Almgren, David S. Owens, Tamara B. Harris, Gina M. Peloso, Kathleen F. Kerr, Quenna Wong, Albert V. Smith, Matthew J. Budoff, Jerome I. Rotter, L. Adrienne Cupples, Stephen Rich, Sekar Kathiresan, Marju Orho-Melander, Vilmundur Gudnason, Christopher J. O’Donnell, Wendy S. Post, George Thanassoulis. Association of Low-Density Lipoprotein Cholesterol–Related Genetic Variants With Aortic Valve Calcium and Incident Aortic Stenosis. JAMA, 2014; DOI: 10.1001/jama.2014.13959

 

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