Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada.
Can J Cardiol. 2021 Jul;37(7):1016-1026. doi: 10.1016/j.cjca.2021.02.017. Epub 2021 Mar 4.
Aortic stenosis is one of the most common cardiovascular diseases in the world. Extensive work on the underlying pathophysiology responsible for calcific aortic valve disease and its progression to aortic stenosis has described a complex process involving inflammation, lipid deposition, mineralisation, and genetic factors such as elevated lipoprotein(a). With the advancement of gene silencing technology and development of novel therapeutic agents, we may now be closer than ever to having medical therapies that prevent, or at least slow the progression of aortic stenosis. In this review, we highlight the pathophysiology and risk factors of calcific aortic valve disease, along with current, potential, and emerging novel medical therapies. We also provide potential explanations for the failure of statin trials and suggest new avenues for research and new randomised trials in this area.
主动脉瓣狭窄是世界上最常见的心血管疾病之一。大量关于导致钙化性主动脉瓣疾病及其进展为主动脉瓣狭窄的基础病理生理学的研究描述了一个复杂的过程，涉及炎症、脂质沉积、矿化和遗传因素，如脂蛋白(a)升高。随着基因沉默技术的进步和新型治疗药物的开发，我们现在可能比以往任何时候都更接近拥有预防或至少减缓主动脉瓣狭窄进展的医学疗法。在这篇综述中，我们强调了钙化性主动脉瓣疾病的病理生理学和危险因素，以及目前、潜在和新兴的新型医学疗法。我们还为他汀类药物试验的失败提供了潜在的解释，并为该领域的研究和新的随机试验提出了新的途径。
