Kazuhiro Yamamoto1, Yukihiro Koretsune2, Takashi Akasaka3, Akira Kisanuki4, Nobuyuki Ohte5, Takashi Takenaka6, Masaaki Takeuchi7, Kiyoshi Yoshida8, Kazunori Iwade9, Yuji Okuyama10, Yutaka Hirano11, Yasuharu Takeda12, Yasumasa Tsukamoto12, Yoshiharu Kinugasa13, Satoshi Nakatani14, Takashi Sakamoto15, Katsuomi Iwakura16, Takashi Sozu17, Tohru Masuyama18. 1. Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: ykazuhiro@med.tottori-u.ac.jp. 2. Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan. 3. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. 4. School of Health Sciences, Kagoshima University, Kagoshima, Japan. 5. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 6. Department of Cardiology, National Hospital Organization, Hokkaido Medical Center, Sapporo, Japan. 7. Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. 8. Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan. 9. Department of Cardiology, National Hospital Organization, Yokohama Medical Center, Yokohama, Japan. 10. Division of Cardiology, Osaka General Medical Center, Osaka, Japan. 11. Division of Central Clinical Laboratory, Kindai University Hospital, Osakasayama, Japan. 12. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan. 13. Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan. 14. Department of Health Sciences, Division of Functional Diagnostics, Osaka University Graduate School of Medicine, Suita, Japan. 15. Department of Cardiology, Fukuchiyama City Hospital, Fukuchiyama, Japan. 16. Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan. 17. Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan. 18. Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Abstract
BACKGROUND: The prevalence of atrial fibrillation (AF) is high in elder subjects. Our previous observational study suggested that vitamin K antagonist (VKA) promotes aortic valve degeneration, a principal cause of aortic stenosis in the elderly, and that angiotensin receptor blocker (ARB) attenuates its progression. This study aimed to prospectively investigate these observations in non-valvular AF patients. METHODS: Of enrolled 430 patients with calcification on no or one aortic valve leaflet, all of the planned 4-year follow-up data were obtained in 122 non-valvular AF patients treated with warfarin (warfarin group) and 101 patients with cardiovascular diseases and without AF and prescription of warfarin (non-warfarin group). RESULTS: Despite higher atherosclerotic risks in the non-warfarin group, 2 or 3 newly calcified leaflets emerged during 4years in 18.0% of patients in the warfarin group and in 6.9% in the non-warfarin group (p=0.014). Aortic valve area (AVA) did not significantly change in the non-warfarin group during the follow-up, but tended to decrease in the warfarin group (p=0.057). Non-vitamin K antagonist oral anticoagulant got available in Japan after this study started, and warfarin was discontinued in 15 patients of the warfarin group. The reduction of AVA was significant in the remaining 107 patients on the continuous warfarin treatment (p=0.002). The effects of ARB on AVA were obscure. CONCLUSION: Major bleeding associated with VKA is well recognized. This study suggests that the development of aortic valve degeneration is another risk of long-term use of VKA in non-valvular AF patients with no or mild aortic valve degeneration.
BACKGROUND: The prevalence of atrial fibrillation (AF) is high in elder subjects. Our previous observational study suggested that vitamin K antagonist (VKA) promotes aortic valve degeneration, a principal cause of aortic stenosis in the elderly, and that angiotensin receptor blocker (ARB) attenuates its progression. This study aimed to prospectively investigate these observations in non-valvular AFpatients. METHODS: Of enrolled 430 patients with calcification on no or one aortic valve leaflet, all of the planned 4-year follow-up data were obtained in 122 non-valvular AFpatients treated with warfarin (warfarin group) and 101 patients with cardiovascular diseases and without AF and prescription of warfarin (non-warfarin group). RESULTS: Despite higher atherosclerotic risks in the non-warfarin group, 2 or 3 newly calcified leaflets emerged during 4years in 18.0% of patients in the warfarin group and in 6.9% in the non-warfarin group (p=0.014). Aortic valve area (AVA) did not significantly change in the non-warfarin group during the follow-up, but tended to decrease in the warfarin group (p=0.057). Non-vitamin K antagonist oral anticoagulant got available in Japan after this study started, and warfarin was discontinued in 15 patients of the warfarin group. The reduction of AVA was significant in the remaining 107 patients on the continuous warfarin treatment (p=0.002). The effects of ARB on AVA were obscure. CONCLUSION: Major bleeding associated with VKA is well recognized. This study suggests that the development of aortic valve degeneration is another risk of long-term use of VKA in non-valvular AFpatients with no or mild aortic valve degeneration.
Authors: Anna E Bortnick; Shuo Xu; Ryung S Kim; Bryan Kestenbaum; Joachim H Ix; Nancy S Jenny; Ian H de Boer; Erin D Michos; George Thanassoulis; David S Siscovick; Matthew J Budoff; Jorge R Kizer Journal: Atherosclerosis Date: 2019-04-13 Impact factor: 5.162
Authors: Krista Nuotio; Suvi M Koskinen; Laura Mäkitie; Jarno Tuimala; Petra Ijäs; Hanna M Heikkilä; Jani Saksi; Pirkka Vikatmaa; Pia Sorto; Sonja Kasari; Ilari Paakkari; Heli Silvennoinen; Leena Valanne; Mikko I Mäyränpää; Lauri Soinne; Petri T Kovanen; Perttu J Lindsberg Journal: Front Neurol Date: 2021-07-12 Impact factor: 4.003