Progression of Aortic Valve Calcification

Abstract

Background-Recent studies demonstrated an influence of atherosclerotic risk factors on the progression of aortic valve stenosis. The extent of aortic valve calcification (AVC) was also found to be a strong predictor of stenosis progression. We investigated the influence of the LDL cholesterol level (LDL), other standard cardiovascular risk factors, and the extent of coronary calcification (CC) on the progression of AVC quantified by electron beam tomography (EBT). Methods and Results-In 104 patients (64.7Ϯ8 years, 89 male) with an EBT scan positive for AVC, CC and AVC were quantified using a volumetric score. EBT was repeated at a mean interval of 15 months (10 to 36 months), and the progression of AVC and CC was determined. Patients were divided into 2 groups according to LDL: group 1, LDLՅ3.36 mmol/L (130 mg/dL), 57 patients; group 2, LDLϾ3.36 mmol/L (130 mg/dL), 47 patients. Mean values for CC were 546Ϯ932 mm 3 in scan 1 and 665Ϯ1085 mm 3 in scan 2 for AVC 324Ϯ796 mm 3 and 404Ϯ1076 mm 3 , respectively. The mean progression of CC was 27Ϯ37% (group 1, 16Ϯ22%; group 2, 39Ϯ46%, PՅ0.001) and of AVC was 25Ϯ38% (group 1, 9Ϯ22%; group 2, 43Ϯ44%, PՅ0.001). Conclusions-Quantification of AVC by EBT permits new insights into the progression of aortic valve sclerosis. We observed a strong influence of LDL cholesterol level on the progression of AVC and CC, suggesting that lipid-lowering therapy may decrease the progression of aortic valve calcification.

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

“…Although aortic stenosis (AS) is robustly associated with adverse outcomes,2, 3 aortic sclerosis has also been associated with an increased risk of cardiovascular morbidity and mortality,4 and aortic sclerosis is a significant risk factor for progression to AS 5. More important, AV calcification and stenosis are associated with similar risk factors as atherosclerosis,1, 6, 7 and a wealth of data now point towards parallel active processes leading to AV dysfunction, including inflammation, lipid deposition, and calcification 8…”

The role of statin treatment in valvular heart disease: is the jury still out?

“…Several factors have been associated with aortic valve stenosis and sclerosis progression, such as advanced patient age, male gender, obesity, smoking, hypertension, diabetes mellitus, coronary artery disease 9,10 . There is clinical evidence of an association between aortic valve lesion and dyslipidaemia, such as increased total serum cholesterol, low-density lipoprotein (LDL), lipoprotein Lp(a) concentration and decreased high-density lipoprotein levels (HDL) 10,11 .…”

“…There is clinical evidence of an association between aortic valve lesion and dyslipidaemia, such as increased total serum cholesterol, low-density lipoprotein (LDL), lipoprotein Lp(a) concentration and decreased high-density lipoprotein levels (HDL) 10,11 . The oxidized lipoproteins are cytotoxic and capable of stimulating inflammatory activity and mineralization.…”

Chlamydia pneumoniae e Mycoplasma pneumoniae nos nódulos de calcificação da estenose da valva aórtica

“…Atheromatous plaques and calcification of nonrheumatic aortic valves seem to have a similar pathogenesis 2 . Valves with AS often exhibit inflammatory changes with infiltration of macrophages and T lymphocytes around calcified nodules, which resemble the inflammatory response seen in coronary atherosclerosis 2 . Furthermore, cholesterol deposits precede the calcified nodes in AS.…”

“…Furthermore, cholesterol deposits precede the calcified nodes in AS. The same clinical risk factors usually associated with coronary artery disease are associated with nonrheumatic calcific aortic stenosis [2][3][4][5][6][7] . These include older age, male sex, increased serum levels of low-density lipoprotein (LDL) and Lp (a) lipoprotein 8 , smoking, hypertension, diabetes, hypercholesterolemia 9 .…”