Ascending aortic estrogen receptor positivity and aortic valve stenosis

There is increasing awareness that the aortic valve may be involved in the pathophysiology of the ascending aorta (1). Age, sex, and osteoporosis may impact the physiopathology of atherosclerosis and aortic valve stenosis (2-5), along with reninangiotensin activation, nitric oxide, and noradrenaline (4). Structurally, the aortic valve is directly connected to the media layer of the ascending aorta, highlighting the important functional and anatomical connection of the aortic valve, the aortic root, and the ascending aorta (e.g., a severely stenotic aortic valve is often found inside a stiff atherosclerotic aortic root) (1). As steroid hormones, estrogens have gained abundant interest in terms of vascular pathology (2). There are 2 different estrogen receptors (ER), ER1 and ER2. In particular, ER2 modulates the vasculature through inflammation, regulates smooth muscle cells proliferation, the vascular tone, and neovascularization (6, 7), all of which play a role in inducing anti-atherosclerosis (6).