Abstract
Calcific aortic valve stenosis (CAVS), the most common heart valve disease, is characterized by the slow progressive fibro-calcific remodeling of the valve leaflets, leading to progressive obstruction to the blood flow. CAVS is an increasing health care burden and the development of an effective medical treatment is a major medical need. To date, no effective pharmacological therapies have proven to halt or delay its progression to the severe symptomatic stage and aortic valve replacement represents the only available option to improve clinical outcomes and to increase survival. In the present report, the current knowledge and latest advances in the medical management of patients with CAVS are summarized, placing emphasis on lipid-lowering agents, vasoactive drugs, and anti-calcific treatments. In addition, novel potential therapeutic targets recently identified and currently under investigation are reported.
Highlights
Calcific aortic valve stenosis (CAVS) is the most common heart valve disease in the Western World and the third cause of cardiovascular disease after coronary artery disease and systemic arterial hypertension [1]
The PubMed, Scopus, and Google Scholar databases were searched by using the key terms “calcific aortic valve disease”, “aortic valve stenosis”, and “valvular interstitial cells”, selecting the most relevant articles
A meta-analysis of the above-reported clinical trials concluded that the protective effect of statins in CAVS patients was detected by low-quality studies, but it was not confirmed by high-quality studies, where the treatment failed to show any significant improvement in clinical outcomes [32]
Summary
Calcific aortic valve stenosis (CAVS) is the most common heart valve disease in the Western World and the third cause of cardiovascular disease after coronary artery disease and systemic arterial hypertension [1]. The prevalence increases with advancing age, reaching 12% in the elderly (>75 years) [2,3]. Its prevalence and impact on public health are expected to increase due to higher life expectancy and the rapid aging of populations worldwide [4]. The disease remains asymptomatic until it reaches the severe stage, where it manifests with syncope, angina, and heart failure, and requires the substitution of the valve [5]. There are no effective medical therapies to halt or delay CAVS progression and the only available option to treat subjects with symptomatic severe CAVS remains surgical or transcatheter aortic valve replacement (AVR) with a mechanical or bioprosthetic valve. The two techniques are associated with significant complications: the implantation of a mechanical valve increases the risk of thrombosis and requires a life-long anticoagulation therapy. The development of an effective medical treatment is a major medical need in order to reverse the progression of CAVS, to improve clinical outcomes, and to reduce the need for AVR
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