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This work was supported by grants from the Spanish Ministry of Economy and Competitiveness PI15/01983, Gobierno de Aragon and CIBERCV. These projects were co-financed by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF) of the European Union A way to make Europe. Martin. Laclaustra's research activity was funded by Agencia Aragonesa para la Investigacion y el Desarrollo (ARAID).

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Ortega-Martinez De Victoria, EmilioAuthorSitges, MartaAuthor

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April 21, 2020
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Aortic Valvular Disease in Elderly Subjects with Heterozygous Familial Hypercholesterolemia: Impact of Lipid-Lowering Therapy

Publicated to:Journal Of Clinical Medicine. 8 (12): - 2019-12-01 8(12), DOI: 10.3390/jcm8122209

Authors: Marco-Benedi, Victoria; Laclaustra, Martin; Casado-Dominguez, Juan M.; Villa-Pobo, Rosa; Mateo-Gallego, Rocio; Sanchez-Hernandez, Rosa M.; Blanco Nuez, Marta; Ortega-Martinez de Victoria, Emilio; Sitges, Marta; Pedro-Botet, Juan; Puzo, Jose; Villarroel, Teresa; Civeira, Fernando;

Affiliations

Hosp Clin Barcelona, CIBEROBN, Lipid Clin, Barcelona 08036, Spain - Author
Hosp del Mar, Lipid Unit, Barcelona 08003, Spain - Author
Hosp Insular Gran Canaria, Endocrinol Dept, Las Palmas Gran Canaria 35016, Spain - Author
Hosp San Jorge, Cardiol Dept, Huesca 22004, Spain - Author
Hosp San Jorge, Lipid Unit, Huesca 22004, Spain - Author
Hosp Univ Dr Negrin, Cardiol Dept, Las Palmas Gran Canaria 35012, Spain - Author
Hosp Univ Miguel Servet, Cardiol Dept, Zaragoza 50009, Spain - Author
Hosp Univ Miguel Servet, Lipid Unit, CIBERCV, IIS Aragon, Zaragoza 50009, Spain - Author
Univ Zaragoza, E-50009 Zaragoza, Spain - Author
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Abstract

Hypercholesterolemia and statins are risk factors for aortic stenosis (AS) and vascular calcification, respectively. Whether heterozygous subjects with familial hypercholesterolemia (HeFH) treated with statins are at risk of AS is unknown. We study the prevalence of AS, aortic valve calcification (AoVC), and aortic sclerosis (ASc) in elderly subjects with HeFH in a prolonged statin treatment. Case-control study, cases were adults >= 65 years of age with a genetic diagnosis of HeFH, LDLc >220 mg/dl, and statin treatment >= 5 years. Controls were relatives of HeFH patients, with LDLc <190 mg/dl. Participants underwent a cardiac ultrasound for aortic valve analysis. We studied 205 subjects, 112 HeFH and 93 controls, with mean age 71.8(6.5) years and 70.0(7.3) years, respectively. HeHF, with respect to controls, presented greater gradients of aortic transvalvular pressure, 7.4(7.3) mmHg versus 5.0(2.8) mmHg, and maximum aortic velocity, 1.7(0.7) m/s versus 1.5(0.4) m/s, and lower aortic valve opening area, 2.0(0.7) cm(2) versus 2.4(0.6) cm(2) (all p < 0.05). AoVC and ASc were also more prevalent in HeFH (p < 0.05 between groups). Moderate/severe AS prevalence was higher among HeFH: 7.1% versus 1.1% (age- and sex-adjusted odds ratio (OR) 8.33, p = 0.03). Independent risk factors for aortic valve disease in HeFH were age and LDLc before treatment. The number of years under statin treatment was not associated with any aortic valve measurement. Subjects >= 65 years with HeFH in prolonged statin treatment show more aortic valvular disease and higher frequency of AS than controls. Life-long elevated LDLc exposure, rather than time of exposure to statins, explains this higher risk.

Keywords

aortic sclerosisaortic stenosisaortic valve calcificationatherosclerosisdiagnosisheterozygous familial hypercholesterolemialdl cholesterolmanagementprevalenceprogressionriskrosuvastatinsimvastatinstatinsstenosisAortic sclerosisAortic stenosisAortic valve calcificationAtherosclerosisDiagnosisHeterozygous familial hypercholesterolemiaLdl cholesterolManagementPrevalenceProgressionRiskRosuvastatinSimvastatinStatinsStenosisValve calcification

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Clinical Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2019, it was in position 36/165, thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine, General & Internal.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 3.15, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-16, the following number of citations:

  • WoS: 4
  • Europe PMC: 4

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-16:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 25.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 28 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.
  • The number of mentions on the social network X (formerly Twitter): 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.