Slower Progress of Aortic Valve Calcification With Vitamin K Supplementation

Abstract

Calcific aortic stenosis is a common degenerative disease characterized by progressive aortic valve calcification (AVC).1 Effective medical treatment options to retard the progression of AVC are sparse.1 Epidemiological data point to vitamin K as a potential protective factor for cardiovascular health, particularly for protection against vascular calcification.2,3 Matrix Gla-protein (MGP), a potent inhibitor of cardiovascular calcification, requires vitamin K for posttranslational carboxylation and hence full bioactivity.4 Thus, vitamin K supplementation might retard the progression of AVC.1,2 Dephosphorylated undercarboxylated MGP (dp-ucMGP) serves as a circulating marker for vitamin K deficiency.2,3 We performed a 12-month prospective, single-center, open-label, randomized interventional trial in patients with asymptomatic or mildly symptomatic AVC. Written informed consent was obtained before inclusion in the trial (URL: http://www.clinicaltrials.gov. Unique identifier: NCT00785109; RWTH Aachen Institutional Review Board No. 165/08). Inclusion criterion was a peak flow velocity exceeding 2 m/s. The main exclusion criteria were chronic kidney disease (estimated glomerular filtration rate <60 mL·min−1·1.73 m−2), expected valve replacement within the next year, and anticoagulation with vitamin K antagonists. Patients were randomized 1:1 to receive 2 mg phytomenadione (vitamin …