Department of Cardiology, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eivenių g. 2, 50161 Kaunas, Lithuania.
Medicina (Kaunas). 2018 Apr 25;54(2):24. doi: 10.3390/medicina54020024.
Degenerative aortic stenosis (DAS) is the most frequently diagnosed heart valve disease in Europe and North America. DAS is a chronic progressive disease which resembles development of atherosclerosis. Endothelial dysfunction, lipid infiltration, calcification and ossification are evidenced in both diseases. The same risk factors such as older age, male sex, smoking, and elevated levels of lipids are identified. The effect of smoking, visceral obesity, metabolic syndrome, hypercholesterolemia, low-density lipoprotein, high-density lipoprotein, lipoprotein(a), adiponectin and apolipoprotein(a) on development of DAS are being studied. The search for genetic ties between disorders of lipid metabolism and DAS has been started. DAS is characterized by a long symptom-free period which can last for several decades. Aortic valve replacement surgery is necessary when the symptoms occur. The lipid-lowering therapy effect on stopping or at least slowing down the progression of DAS was studied. However, the results of the conducted clinical trials are controversial. In addition, calcium homeostasis, bone metabolism and calcinosis-reducing medication are being studied. Although prospective randomized clinical trials have not demonstrated any positive effect of statins used for slowing progression of the disease, statins are still recommended for patients with dyslipidemia. Recent study has suggested that a specific modification of treatment, based on severity of disease, may have a beneficial effect in patients with aortic sclerosis and mild DAS. New clinical studies analyzing new treatment possibilities which could correct the natural course of the disease and reduce the need for aortic valve replacement by surgery or transcatheter treatment interventions are needed.
退行性主动脉瓣狭窄（DAS）是欧洲和北美的最常见的心脏瓣膜疾病。DAS 是一种慢性进行性疾病，类似于动脉粥样硬化的发展。内皮功能障碍、脂质浸润、钙化和骨化在这两种疾病中都有证据。相同的危险因素，如年龄较大、男性、吸烟和血脂水平升高，也被确定。吸烟、内脏肥胖、代谢综合征、高胆固醇血症、低密度脂蛋白、高密度脂蛋白、脂蛋白（a）、脂联素和载脂蛋白（a）对 DAS 发展的影响正在研究中。已经开始寻找脂质代谢紊乱和 DAS 之间的遗传联系。DAS 的特点是无症状期很长，可以持续几十年。当出现症状时，需要进行主动脉瓣置换手术。研究了降脂治疗对停止或至少减缓 DAS 进展的效果。然而，进行的临床试验结果存在争议。此外，还研究了钙平衡、骨代谢和减少钙化药物。尽管前瞻性随机临床试验并未显示用于减缓疾病进展的他汀类药物有任何积极效果，但仍建议血脂异常患者使用他汀类药物。最近的一项研究表明，基于疾病严重程度的特定治疗方法的改变可能对主动脉瓣硬化和轻度 DAS 患者有益。需要进行新的临床研究，分析新的治疗可能性，以纠正疾病的自然病程，并减少手术或经导管治疗干预对主动脉瓣置换的需求。
