Aortic Stenosis: Pathophysiology, Diagnosis, and Medical Management of Nonsurgical Patients

Abstract

A ortic stenosis is caused by narrowing of the orifice of the aortic valve and leads to obstruction of left ventricular outflow. This stenosis is rare in persons less than 50 years old.1 Calcification of the aortic valve is the most common cause of aortic stenosis in adults in industrialized countries and affects more than 4% of North American and Europeans more than 75 years old.2 In a study 3 of 338 North American patients with severe asymptomatic aortic stenosis, the mean age was 71 (SD, 15) years. Aortic stenosis was also associated with higher morbidity and mortality rates than were diseases involving other cardiac valves. 4 For example, in a study 5 of 161 patients, patients with moderate and

Degenerative Aortic Stenosis, Dyslipidemia and Possibilities of Medical Treatment

“…It was determined in a prospective Cardiovascular Health Research study (CHR) that aortic sclerosis prevalence was 26% and DAS–2% of 5,201 patients who were over 65 years old. Aortic sclerosis prevalence was 48% and DAS–4% of the patients who were over 85 years old [ 6 ]. DAS is characterized by a long symptom-free period which can last for several decades [ 2 ].…”

“…Rheumatic aortic valve stenosis was predominant in developed countries until 1970. Currently, the predominant cause of aortic valve stenosis is degeneration and calcinosis of aortic valve [ 6 , 7 ]. Historically, DAS has been considered a consequence of long-term “wear” and age-related degeneration of valves [ 6 , 7 , 8 , 9 ].…”

“…Currently, the predominant cause of aortic valve stenosis is degeneration and calcinosis of aortic valve [ 6 , 7 ]. Historically, DAS has been considered a consequence of long-term “wear” and age-related degeneration of valves [ 6 , 7 , 8 , 9 ]. Calcinosis of aortic valve was the disease of the elderly; however, it has been proven that DAS is not a consequence of aging only [ 7 ].…”

“…It has been determined that dyslipidemia was more frequently diagnosed for the patients with an aortic valve prosthesis with or without coronary artery bypass grafting (CABG) surgery than for those for whom CABG only was performed. Therefore, it is believed that DAS and CAD share common etiological factors [ 5 , 6 , 10 , 12 ]. In the CHR study, it was determined that DAS is significantly related to older age, male sex, smoking, arterial hypertension (AH) as well as elevated levels of lipoprotein(a) (Lp(a)) and low-density lipoprotein (LDL).…”

“…In the CHR study, it was determined that DAS is significantly related to older age, male sex, smoking, arterial hypertension (AH) as well as elevated levels of lipoprotein(a) (Lp(a)) and low-density lipoprotein (LDL). Special focus is given to the influence of cholesterol [ 6 , 10 ]. Lipid theory in the development of DAS is analyzed.…”