Aortic sclerosis—a marker of coronary atherosclerosis

Abstract

Summary: Aortic valve sclerosis is defined as calcification and thickening of a trileaflet aortic valve in the absence of obstruction of ventricular outflow. Its frequency increases with age, making it a major geriatric problem. Of adults aged > 65 years, 21-29% exhibit aortic valve sclerosis. Incidence of aortic sclerosis increases with age, male gender, smoking, hypertension, high lipoprotein (Lp) (a), high low-density lipoprotein (LDL), and diabetes mellitus. Aortic valves affected by aortic sclerosis contain a higher amount of oxidized LDL cholesterol and show increased expression of metalloproteinases. Clinically, it can be suspected in the presence of soft ejection systolic murmur at the aortic area, normal split of the second heart sound, and normal volume carotid pulse, but it can be best detected by echocardiography. Aortic sclerosis may be accompanied by mitral annulus calcification up to 50% of cases. It is associated with an increase of approximately 50% in the risk of death from cardiovascular causes and the risk of myocardial infarction. The mechanism by which aortic sclerosis contributes to or is associated with increased cardiovascular risk is not known. Aortic sclerosis is associated with systemic endothelial dysfunction, and a small percentage of cases may progress to aortic stenosis. Lowering of LDL cholesterol by 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have been shown to decrease progression of aortic valve calcification. Aortic sclerosis is not a mere benign finding. Once diagnosis of aortic sclerosis has been made, it should be considered a potential marker of coexisting coronary disease. Aggressive management of modifiable risk factors, especially LDL cholesterol lowering, may slow progression of the disease.

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

“…Multiple studies support the presence of shared pathologic pathways between calcific AV disease and atherosclerosis 29. Calcific AV disease and atherosclerosis share common risk factors, such as age, smoking, hypertension, hypercholesterolemia, diabetes mellitus, and metabolic syndrome 1, 30, 31.…”

Decreased levels of soluble receptor for advanced glycation end-products in aortic valve calcification patients

“…With regard to pathophysiology, it has been proven that early lesions of AVC implicate active processes similar to atherosclerosis, such as lipid deposition, macrophage infiltration, and production of osteopontin as well as other proteins (Rajamannan, 2010). Further changes associated with extracellular matrix remodeling and neovascularization ultimately lead to active calcification (Prasad and Bhalodkar, 2004;Helske et al, 2007). Experimental animal models of AVC (Rajamannan et al, 2005;Drolet et al, 2006) demonstrated that early lesions contained inflammatory cells.…”

Assessment of Aortic Valve Sclerosis as a Marker of Coronary Artery Disease and Its Risk Factors.

“…In 2002, Kirsten and his colleagues studied the morphologic classification system for AVS by transesophageal echocardiography and correlated the subtypes of AVS with the presence of cardiovascular disease, and they concluded that it is possible to identify a subgroup of patients with mixed nodular and diffuse sclerosis, were at increased risk for CAD including multivessel disease 14 . In 2006, Serdar et al 15 , studied the association between AVS and the extent of coronary atherosclerosis by means of the Gensini score system, and he concluded that AVS is strongly interrelated with the coronary angiographic results. Echocardiographic detection of AVS in patients undergoing coronary angiography can predict the extent of coronary atherosclerosis 15 .…”

“…In 2006, Serdar et al 15 , studied the association between AVS and the extent of coronary atherosclerosis by means of the Gensini score system, and he concluded that AVS is strongly interrelated with the coronary angiographic results. Echocardiographic detection of AVS in patients undergoing coronary angiography can predict the extent of coronary atherosclerosis 15 . Another study concluded that pathologic processes that may occur in coronary arteries may be identified more easily in the aortic valve and they suggest that once the diagnosis of AVS has been made by echocardiography, it should be considered as a potential marker of CAD, and patients who are diagnosed with AVS should undergo intensive screening for CAD with aggressive management for modifiable risk factors.…”