Medical treatments in aortic stenosis: Role of statins and angiotensin-converting enzyme inhibitors

CALCIFIC AROTIC STENOSIS AND ATHEROSCLEROSIS: Aortic stenosis is the most frequent valvular heart disease in western world and its incidence continues to rise. Aortic sclerosis is the first characteristic lesion of the cusps, which is today considered a process similar to atherosclerosis. The progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. Aortic stenosis is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. MEDICAL TREATMENT FOR AORTIC STENOSIS: The need for alternative to aortic valve surgery is highlighted by increasing longevity of the population and new therapeutic strategies to limit disease progression are needed to delay or potentially avoid, the need for valve surgery. Currently, there are no established disease modifying treatments in regard to the progression of aortic stenosis. The first results about influence of angiotensin-converting enzyme inhibitors and statins on aortic sclerosis and stenosis progression are promising. Statins are likely to reduce cardiovascular events rather than disease progression, but may be potentially a valuable preventive treatment in these patients. The prejudice against the use of angiotensin-converting enzyme inhibitors by patients with aortic stenosis is changing. The cautious use of angiotensin-converting enzyme inhibition by patients with concomitant hypertension, coronary artery disease, and heart failure seems appropriate. Definite evidence from large clinical trials is awaited.