Understanding the driving mechanisms of bioprosthetic valve degeneration

Over the last decade, it has become increasingly clear that different mechanisms drive the development of native aortic stenosis. Most patients who develop native aortic stenosis have hypertension, and some have increased cholesterol. However, male sex, body mass index, smoking, metabolic syndrome, renal failure and genetic factors (eg, bicuspid aortic valve) have been identified in epidemiological studies as risk factors for developing native aortic stenosis. These studies have led to a series of clinical variables, which provide the foundation for understanding the mechanisms. The low-density lipoprotein (LDL) radius theory gives a framework for understanding the development of native aortic stenosis.1 In native aortic stenosis, LDL-cholesterol insudates into endothelial cells, resulting in an inflammatory reaction forming increased oxidised phospholipids, leading to osteogenesis. This process is further propagated by high blood pressure; in patients with asymptomatic mild-to-moderate aortic stenosis, blood pressure levels around 130–139 mm Hg/70–90 mm Hg have...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research