Key result
Novel lipid-lowering therapies and NOACs show promise in slowing mild aortic stenosis progression.
Why the study?
Aortic stenosis is a progressive disease lacking pharmacological treatment, with prevalence projected to reach 4.5 million worldwide by 2030.
Do novel pharmacological therapies prevent the progression of mild-to-moderate aortic stenosis?
Do novel pharmacological therapies prevent the progression of mild-to-moderate aortic stenosis?
Answers are grounded in this paper and cite their sources.
Pharmacological therapies targeting lipid pathways and coagulation show promise as potential non-surgical treatments to slow the progression of mild-to-moderate aortic stenosis.
BACKGROUND: Aortic stenosis (AS) prevalence is estimated to reach 4.5 million cases worldwide by the year 2030. AS is a progressive disease without a pharmacological treatment. In the current review, we aimed to investigate novel therapeutic approaches for non-surgical AS treatment, at least in patients with mild-to-moderate AS. MATERIALS AND METHODS: The most recent and relevant papers concerned with novel molecular pathways that have potential as therapeutic targets in AS were selected from searches of PubMed and Web of Science up to February 2021. RESULTS: Growing evidence indicates that therapies using proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, simvastatin/ezetimibe combination, cholesteryl ester transfer protein inhibitors or antisense oligonucleotides targeting apolipoprotein(a) reduce the risk of AS progression. It has been shown that enhanced valvular lipid oxidation may drive AS development by leading to the activation of valvular interstitial cells (VICs), the most abundant valvular cells having a major contribution to valve calcification. Since VICs are able to release pro-inflammatory cytokines, clotting factors and proteins involved in calcification, strategies targeting these cell activations seem promising as therapeutic interventions. Recently, non-vitamin K antagonist oral anticoagulants (NOACs) have been shown to inhibit activation of VICs. CONCLUSION: Several novel molecular pathways of AS development have been identified over the past few years. Therapies using PCSK9 inhibitors, simvastatin/ezetimibe combination, lipoprotein(a)-lowering therapy are highly promising candidates as therapeutics in the prevention of mild AS progression, while preclinical studies show that NOACs may inhibit valvular inflammation and coagulation activation and slower the rate of AS progression.
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Natorska et al. (2021) conducted a review in Aortic stenosis. Novel therapeutic approaches (PCSK9 inhibitors, simvastatin/ezetimibe, lipoprotein(a)-lowering therapy, NOACs) was evaluated on Aortic stenosis progression. Novel therapies including PCSK9 inhibitors, simvastatin/ezetimibe, lipoprotein(a)-lowering therapy, and NOACs are promising candidates to prevent or slow the progression of mild aortic stenosis.
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