Insulin and statins causing calcification?

[LondonAndy]

My journey through AVR started over 10 years ago now, in 2014, and was needed because of severe stenosis. I don't know why I haven't thought to post this sooner, but a search of past topics doesn't seem to suggest this has been discussed, so here goes, perhaps of interest to those in the waiting room, or indeed simply for some of those who wonder why they needed a valve replaced.

After my operation, my surgeon described my diseased valve as being "as white as a piece of cauliflower", and said that it was now thought (by 2014) that the combination of insulin and statins causes calcification. By 2014 I had been on insulin for 8 years and statins for over 20 years, owing to a strong family history of cardiac issues. So this certainly seemed plausible, and some amateur Googling finds that even statins on their own are likely to cause calcification, as does insulin resistance. So as is often the case in medicine it seems, we solve one problem but cause another!

 

[pellicle]

Wow, Andy, thats bloody terrible news.

 

[V__]

some amateur Googling finds that even statins on their own are likely to cause calcification, as does insulin resistance. So as is often the case in medicine it seems, we solve one problem but cause another!

Cannot comment on the insulin part. For the statins and calcification, I followed your link and the references in that article. The explanation offered is that there are 2 changes: 1) increase of calcification and the "hard" part of a plaque, 2) reduction of its soft part. So in the end the plaque becomes more stable after such remodeling. Besides the measurements, the other supporting evidence is that there was no increase of the stroke events, in spite of the increased calcification.

It's possible that there are more "dimensions" of this, and I cannot comment on the valve calcification or the insulin impact. But I guess the calcification is not always bad by itself?

 

[Chuck C]

Cannot comment on the insulin part. For the statins and calcification, I followed your link and the references in that article. The explanation offered is that there are 2 changes: 1) increase of calcification and the "hard" part of a plaque, 2) reduction of its soft part. So in the end the plaque becomes more stable after such remodeling. Besides the measurements, the other supporting evidence is that there was no increase of the stroke events, in spite of the increased calcification.

It's possible that there are more "dimensions" of this, and I cannot comment on the valve calcification or the insulin impact. But I guess the calcification is not always bad by itself?

That is correct. It is well published that one of the ways in which statins reduce the risk of events is by stabilizing soft plaque, which is generally the much more dangerous type at risk of rupture, leading to heart attack or stroke. It stabilizes these plaques essentially by causing them to calcify. It is very common for an individual with significant heart disease to realize a significant increase in CAC score one year after going on statin, but this comes with a corresponding decrease in soft plaque and decrease in events in the long term.

The above is pertaining to the effect of statins on heart disease, not valve disease. The effect of statins on the progression of valve disease is well studied. The results are mixed, with studies showing either slowing down of aortic stenosis, or no effect on the progression. I linked a few studies below. I am not aware of any data suggesting that statins accelerate aortic stenosis.

"In conclusion, in a large series of patients with long-term follow-up, statins were effective in slowing the progression of aortic valve disease in aortic sclerosis and mild AS, but not in moderate AS. These results suggest that statin therapy should be taken into consideration in the early stages of this common disease."

https://www.ajconline.org/article/S0002-9149(08)00847-3/abstract

"Conclusions Currently available data do not support the use of statins to improve outcomes and to reduce disease progression in non-rheumatic calcific aortic valve stenosis."

https://heart.bmj.com/content/97/7/523

Conclusions— ACEIs do not appear to slow AS progression. However, statins significantly reduce the hemodynamic progression of both mild-to-moderate and severe AS, an effect that may not be related to cholesterol lowering.

https://www.ahajournals.org/doi/10.1161/01.CIR.0000140723.15274.53


Bottom line, if you are a patient with heart disease or valve disease, do not stop taking your statins, but discuss with your cardiologist any concerns that you may have.