Degeneration of native and tissue prosthetic valve in aortic position: Do statins play an effective role in prevention?

Degenerative aortic valve stenosis is a common disease in western countries. When it becomes severe, it confers significant morbidity and mortality. Aortic stenosis has been recognized as a complex inflammatory and highly regulated process with histological and immunochemical similarities with the process of atherosclerosis. Hypertension, smoking and diabetes mellitus have consistently been linked to the development of aortic stenosis. Endothelial injury or other processes that contribute to coronary disease may play a role in calcific aortic stenosis. Several observational studies suggests that the key factors of aortic stenosis are lipoproteins and that medical therapies with cholesterol lowering drugs may retard its progression. Similarly, it has been suggested that the process of degeneration of the tissue heart valve has been associated with the same risk factors of atherosclerosis and shares many histological and molecular characteristics. Assuming all this concept, and evaluating the results of a retrospective study it has been suggested to use statin also as medical therapy able to prevent tissue valve degeneration. Randomized controlled clinical trials will be needed to demonstrate the role of lipid intervention to prevent the progression of aortic stenosis and the degeneration of tissue heart valves.