Role of statins in valvular heart disease: Rheumatic valve disease and bioprosthetic valves

Abstract

Although rare nowadays in North America and Europe, rheumatic heart disease (RHD) continues to be an important healthcare problem in developing countries with an estimated prevalence of 15.6 million people worldwide and 470,000 newly diagnosed cases every year (Carapetis et al. 2005). Acute rheumatic fever leads to an abnormal immune response to the infection with rheumatogenic group A hemolytic streptococci leading to pancarditis with acute inflammation of the leaflets. Inflammation, fibrosis and calcification lead to alterations of the cusps and valvular apparatus, leading to mitral, aortic and/or tricuspid stenosis and/or regurgitation that will eventually become symptomatic. The mitral valve is commonly involved more often leading to mitral stenosis meanwhile isolated aortic or tricuspid involvement is rare (Marijon et al. 2007). Typical aspects of rheumatic involvement in valve disease are represented by adhesions and fusions of the commissures with cusp retraction and stiffening of the free borders of the cusps (Bonow et al. 2006).