CAN WE PREVENT CALCIFIC AORTIC VALVE STENOSIS?

ortic valve stenosis occurs when there is calcification and restriction of the movement of the aortic valve leaflets. This would impede the flow of blood out of the heart. This condition is treated with transcatheter aortic valve implantation (TAVI) or surgical valve replacement. There are currently no recommended medication-based treatment or prevention of degenerative calcific aortic valve stenosis. There are however known risk factors for aortic stenosis. These include non-modifiable risk factors such as increasing age and male gender. We should however focus on the potentially modifiable ones (Table 1)¹.

Table 1 

There have also been increasing interests in the newer concepts of how aortic stenosis develops and these may present opportunities for the development of effective treatment (Figure 1). Although some contemporary trials have shown that cholesterol lowering (statin) therapy2 and drugs for treating osteoporosis3 (denosumab and alendronate) to suppress abnormal mineralization have not proven yet to be effective, other clinical trials are ongoing (e.g. use of PCSK inhibitors-another cholesterol lowering therapy, Vitamin K2 supplementation). Another common question raised is if calcium supplementation can worsen aortic valve calcification, the answer is unfortunately still elusive as studies have been contradictory^4,5.

_References:

1. _{Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29(3):630-634. doi:10.1016/s0735- 1097(96)00563-3}
2. _{Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008 Sep 25;359(13):1343-56. doi: 10.1056/NEJMoa0804602.}
3. _{Pawade TA, Doris MK, Bing R, et al. Effect of Denosumab or Alendronic Acid on the Progression of Aortic Stenosis: A Double-Blind Randomized Controlled Trial. Circulation.2021 Apr 29. doi: 10.1161/CIRCULATIONAHA.121.053708.}
4. _{Bhakta M, Bruce C, Messika-Zeitoun D, et al. Oral calcium supplements do not affect the progression of aortic valve calcification or coronary artery calcification. J Am Board Fam Med. 2009 Nov-Dec;22(6):610-6. doi: 10.3122/jabfm.2009.06.080217. Erratum in: J Am Board Fam Med. 2012 Mar;25(2):262. PMID: 19897688.}
5. _{Antonette Karrthik, Keerat Rai Ahuja, Mohamed M Gad, et al. Does Vitamin D/Calcium Supplement Intake Worsen Aortic Stenosis Progression? Circulation. 2019;140:A15768}