Rheumatic heart disease is a major cause of mitral stenosis, particularly in developing countries. Rheumatic mitral stenosis is a gradually progressive disease and in due course of time, stenosis becomes severe. The levels of C-reactive protein (CRP), proinflammatory cytokines and circulating adhesion molecules have been found to be raised in patients with long-standing disease.

The role of statins in rheumatic MC has been investigated in studies and findings from a retrospective study published in the journal Circulation have shown slowing of disease progression with statin treatment, an action that has been attributed to their pleiotropic anti-inflammatory properties. The study included 315 patients with rheumatic MS; 35 patients were taking statins, while the remaining 280 patients were not on statins. Women constituted around 70% of the study population.

After a mean follow-up of 6.1 years, a significantly slower progression of MS was observed in the statin group as indicated by lower rates of the decrease in mean mitral valve area compared to non-statin group (0.027 vs 0.067 cm2 per year; p=0.005). The annualized change in mean transmitral gradient was also lower in statin-treated patients (0.20±0.59 vs 0.58±0.96 mm Hg per year; p=0.023). Reduction in the progression of mitral regurgitation was also observed with statin treatment during follow-up.

Rheumatic heart disease, as a cause of valvular heart disease, is highly prevalent in developing countries including India. The usual management is symptomatic medical treatment, percutaneous balloon valvuloplasty, or surgical valvotomy/mitral valve replacement in patients with severe disease. Hence, the availability of a treatment option, which slows the progression of valvular stenosis,  such as statins as demonstrated in this study, would help reduce the public health burden of the disease, especially as the disease predominantly affects the younger and therefore the more productive population group.

(Antonini-Canterin F, et al. Effect of hydroxymethylglutaryl coenzyme-A reductase inhibitors on the long-term progression of rheumatic mitral valve disease. Circulation, 2010 May 18;121(19):2130-6)

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA