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July 22, 2019

Meta-Analysis Shows Midterm Mortality Benefit of Statin Therapy After TAVR

July 22, 2019—A meta-analysis of available studies was performed to determine whether statin (hydroxymethylglutaryl-CoA reductase inhibitor) therapy is associated with better midterm survival after transcatheter aortic valve replacement (TAVR).

Hisato Takagi, MD, et al for the ALICE (All-Literature Investigation of Cardiovascular Evidence) group, published the results online ahead of print by in The American Journal of Cardiology (AJC).

The study investigators searched PubMed, Web of Science, and Google Scholar through March 2019 to identify all observational comparative studies and randomized controlled trials (RCTs) of statin versus control therapy or cohort studies investigating statin treatment as one of the covariates in patients undergoing TAVR. The meta-analysis included eight eligible studies with a total of 5,170 TAVR patients.

From each study, the investigators extracted adjusted (if unavailable, then unadjusted) hazard ratios (HRs) with confidence intervals (CIs) for midterm (≥ 1 year) all-cause mortality after TAVR for statin therapy. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic HRs in the random-effects model.

As reported in AJC, the primary meta-analysis (including HRs for high-intensity statins from three studies together with other HRs) demonstrated that statin treatment was associated with significantly lower midterm mortality (HR, 0.74; 95% CI, 0.60–0.91;  =  .005).

The secondary meta-analysis (including HRs for low/moderate-intensity statins from three studies together with other HRs) also indicated an association of statin therapy with significantly lower midterm mortality (HR, 0.8; 95% CI, 0.69–0.93;  =  .005). No funnel plot asymmetry for the primary meta-analysis was identified ( =  .64), which suggested no publication bias. The study investigators concluded that statin therapy is associated with better midterm survival after TAVR.

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