Markers of Lipid Metabolism Do Not Correlate with the Expression of Aortopathy in Patients with Bicuspid Aortic Valve Disease

BACKGROUND: Controversy exists regarding the potential effects of lipid metabolism on the expression of proximal aortopathy. The study aim was to compare the association between markers of lipid metabolism and the expression of proximal aortopathy in patients with either bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) disease.

METHODS: A total of 458 consecutive patients (68% males) underwent aortic valve replacement (AVR) with or without concomitant aortic surgery between January 2008 and December 2014 at the authors' institution. All patients undergoing combined procedures were excluded. Attention was focused only on those patients who had aortic dimensions quantified by preoperative computed tomography/magnetic resonance imaging and/or transesophageal echocardiography. A correlation analysis was performed between markers of lipid metabolism (e.g., cholesterol, LDL, HDL, and triglyceride) and cross-sectional aortic diameters in BAV patients (n = 273) versus TAV patients (n = 185). Comparisons were also made of correlation patterns between markers of lipid metabolism and proximal aortic diameter in BAV regurgitation (n = 48) versus BAV stenosis (n = 225) cohorts. A logistic regression was performed to analyze predictors of proximal aortic diameter ≥40 mm in BAV and TAV subgroups.

RESULTS: No significant correlation was found between maximal cross-sectional aortic diameters and parameters of lipid metabolism in the whole study population (n = 458). Only preoperative statin therapy was significantly associated with the proximal aortic diameter (OR = 0.64, p = 0.046). Neither was any significant correlation found between markers of lipid metabolism and proximal aortic diameter, separately in BAV and TAV cohorts. Logistic regression revealed a significant association between triglyceride levels and proximal aortic diameter ≥40 mm in the TAV-aortic stenosis (AS) subgroup (OR = 1.4, p = 0.026). Moreover, HDL levels were significantly associated with proximal aortic diameter ≥40 mm in the BAV-AS subgroup (OR = 0.5, p = 0.037).

CONCLUSIONS: No significant correlation was identified between markers of lipid metabolism and proximal aortic diameter in surgical BAV and TAV cohorts. The observed correlation between statin use and proximal aortopathy must be addressed in subsequent studies.