Update on the pathophysiology of aortic stenosis
|
|
- Jocelin Daniels
- 5 years ago
- Views:
Transcription
1 European Heart Journal Supplements (2008) 10 (Supplement E), E4 E10 doi: /eurheartj/sun013 Update on the pathophysiology of aortic stenosis Nalini M. Rajamannan* Division of Cardiology, Department of Pathology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 300 East Chicago Avenue, Tarry , Chicago, IL 60611, USA KEYWORDS Aortic valve stenosis; Pathophysiology; Atherosclerosis; Calcification; Endothelial dysfunction Introduction Calcific aortic stenosis (AS) is the most common valve disorder in the western world. 1 Calcification of an aortic valve was once thought to be a largely passive process, with serum calcium attaching to the surface of a valve leaflet, forming a nodule. Consistent with this understanding, surgical aortic valve replacement (AVR) has been a mainstay of treatment for calcific AS with outflow obstruction 2 and remains the primary treatment modality recommended for symptomatic severe calcific AS. 3,4 Calcific AS is the chief indication for surgical valve replacement 3 and, in the USA, the number of such procedures has been increasing in recent years, The objective of this review is to explain the basis for the current appreciation of the role of active atherosclerotic and bone-forming processes in the pathophysiology of calcific aortic stenosis (AS). Relevant epidemiological, histopathological, and experimental studies are reviewed. Calcific AS and atherosclerosis share similar risk factors, including elevated LDL cholesterol levels, hypertension, male gender, smoking, and diabetes mellitus. Both atherosclerosis and calcific AS often occur in individuals with familial hypercholesterolaemia, and elderly patients with AS are also at an increased risk of myocardial infarction and death from cardiovascular causes. Lipoprotein deposition is prominent in both conditions. Aortic valve mineralisation occurs as the result of mechanisms similar to those active in bone formation, including upregulation of the Lrp5 pathway and the presence of an osteoblast phenotype in calcified valves. An active atherosclerosis-type pathophysiology involving oxidative stress, inflammation, and endothelial dysfunction in aortic valves has been induced by hypercholesterolaemia, and inhibited by administering HMG-CoA reductase inhibitors (statins), in animal models. Evidence of endothelial dysfunction with neovascularisation and an increase in endothelial macrophages and metalloproteinases has been found in surgically excised human valves with calcific AS. The initiating factors and pathophysiology of calcific AS are broadly similar to those of atherosclerosis of coronary and other arteries. The sclerosis and calcification of aortic valves may therefore be addressed with pharmacological therapies that are effective in slowing or reversing atherosclerosis. with isolated AVRs and AVRs in conjunction with coronary artery bypass procedures reported by the Society of Thoracic Surgeons in However, emerging epidemiological, histopathological, and experimental evidence indicates that calcification of an aortic valve is an active rather than a passive biological process within the valve leaflet, causing regulated bone formation. Recent advances have underscored the parallels of this active process to coronary atherosclerosis. The present article reviews the evidence for an atherosclerotic basis to aortic valve calcification and stenosis. Epidemiological evidence * Corresponding author. Tel: þ ; fax: þ address: n-rajamannan@northwestern.edu Similarities in risk factors strongly suggest that a similar process underlies both the development and progression Published on behalf of the European Society of Cardiology. All rights reserved. & The Author For permissions please journals.permissions@oxfordjournals.org.
2 Update on the pathophysiology of aortic stenosis E5 of calcific AS as well as atherosclerosis. Risk factors shared by calcific AS and atherosclerosis include hypertension, elevated LDL cholesterol, male gender, smoking, and diabetes mellitus Epidemiological evidence consistent with these similarities includes the occurrence of valvular heart disease in patients with homozygous familial hypercholesterolaemia, a condition characterised by profoundly elevated LDL cholesterol and premature development of atherosclerosis, 12,13 as well as the connection between aortic valve sclerosis and cardiovascular mortality and morbidity in elderly patients; there is an 50% increased risk of myocardial infarction and death from cardiovascular causes in patients with AS, even among individuals without leftventricular outflow obstruction. 14 Palta et al. 8 investigated the clinical, echocardiographic, and biochemical characteristics that might bear on the rate of progression of AS in a group of 170 consecutive patients who had paired echocardiograms 3 months ( ) apart. Baseline values were leftventricular outflow tract (LVOT) velocity, m/s; peak aortic velocity, m/s; and aortic valve area (AVA) cm 2. The annual reduction in AVA was significantly related to the initial AVA (r ¼ 0.46, P, ), mean aortic valve gradient (r ¼ 20.27, P ¼ 0.04), LVOT velocity (r ¼ 0.26, P ¼ 0.001), and LV end-diastolic diameter (r ¼ 0.20, P ¼ 0.04) and marginally related to the baseline serum creatinine level (r ¼ 0.15, P ¼ 0.08). Patients with a serum cholesterol level.5.18 mmol/l (200 mg/dl) had an AVA reduction rate that was about two times as high as that of patients with lower cholesterol levels (P ¼ 0.04). The investigators concluded that, in patients with AS, increased levels of serum cholesterol, creatinine, and calcium, as well as current smoking, accelerate the reduction in AVA. Histopathological evidence Important histopathological evidence that calcific AS unfolds in ways similar to those of atherosclerosis was reported by O Brien et al., 15 who found that apolipoproteins B and E are present in early as well as advanced aortic valve lesions but not in normal valve regions; a similar pattern of lipoprotein deposition also occurs in coronary atherosclerosis. Evidence that the aortic valve is associated with an active cellular biology was shown in our case report of the appearance of lipid-rich plaque in an aortic valve leaflet, coronary artery, and aorta of a 7-year-old boy, who was born in 1949 with congenital hyperlipidaemia and multiple prominent skin xanthomas. 13 His serum lipid levels included a total cholesterol of 24.6 mmol/l (951 mg/dl); cholesterol esters 17.2 mmol/l (666 mg/dl); and fatty acids 36.6 mmol/l (1,032 mg/dl). At this time, he was treated with a low-animal-fat diet, because the use of tight lipid-lowering treatment regimens was not a common practice. The child had recurrent asthma and, in 1956, had an acute onset of cyanosis and cardiac arrhythmia. He was hospitalised but suddenly became apnoeic and died. Our post-mortem study of the heart in 2003, and examination of tissues by light microscopy after staining, showed lipid-rich plaque with foam cells (similar to findings observed in coronary atherosclerosis) and collagen deposition along the aortic valve leaflet surface (Figure 1). 13 The left circumflex artery was severely narrowed, with evidence of atherosclerosis and acute thrombosis, which was judged to be the likely cause of death. The thoracic aorta also showed evidence of atherosclerosis. The coexistence of these findings in a patient with familial hypercholesterolaemia suggested the possibility of a common underlying pathophysiological disease mechanism for vascular and aortic valve disease. Experimental evidence Several studies have helped to explain the process by which aortic valves become calcified. Mohler et al. 16 demonstrated that osteopontin, a protein in bone matrix that regulates the deposition of calcium, is found in minimally and severely calcified aortic valves and located mainly in the calcified areas (Figure 2). Additional evidence that aortic valve mineralisation is an active biological process, similar to that occurring in bone, derives from our study of surgically removed valves, which demonstrated an osteoblast phenotype. As shown by reverse transcription polymerase chain reaction (RT PCR), increased transcription of genes for osteopontin, bone sialoprotein, osteocalcin, bonespecific transcriptional factor Cbfa1, and glyceraldehyde- 3-phosphate dehydrogenase (GAPDH) (i.e. increased mrna levels) was evident in calcified (vs. normal) aortic valves (Figure 3). 17 In addition to increased gene transcription, certain signal transduction mechanisms that are upregulated in bone formation also seem to be activated in mineralising aortic valve leaflets. In particular, LDL receptor-related protein 5 (Lrp5), osteocalcin, and other bone markers are upregulated in calcified tricuspid and bicuspid aortic valves. 18 In the presence of hypercholesterolaemia, the Lrp5 pathway seems to be activated in mesenchymal myofibroblast cells within the valve, switching them to a bone-producing phenotype. This phenotypic switch occurs through the binding of Lrp5 to the glycoprotein Wnt, which in turn activates b-catenin to induce the formation of bone. Upregulation of osteogenic bone signalling markers may be expressed as cartilage formation in human myxomatous (degenerative) mitral valves and calcification in bicuspid and tricuspid valves (Figure 4). 18 We conducted a study to determine whether Lrp5 plays a role in cellular proliferation and osteoblastogenesis in aortic valves of rabbits rendered hypercholesterolaemic, and whether these processes might be affected by administration of a statin. 19 Three groups of 18 Watanabe rabbits each were studied: Group I received a normal diet, Group II a 0.25% cholesterol diet, and Group III a 0.25% cholesterol diet with atorvastatin. The rabbits aortic valves were examined for cellular proliferation, Lrp5/b-catenin as an indicator of Wnt pathway activation, and bone matrix markers. The
3 E6 N.M. Rajamannan Figure 1 Aortic valve, circumflex coronary artery, and thoracic aorta of a 7-year-old boy. The aortic valve cusp contains atheromatous plaque (arrow) along its aortic aspect (20 magnification; top panels). The circumflex coronary artery is severely stenotic (12 magnification; middle panels). The thoracic aorta contains a shallow intimal plaque (arrowhead; x12 magnification). Reprinted with permission from N Engl J Med. 13 Copyright & 2003 Massachusetts Medical Society. All rights reserved. cholesterol-enriched diet resulted in bone formation in the calcified valves, with increased expression of Lrp5 receptors, osteopontin, and p42/44 (an indicator of cellular proliferation). In this study, administration of atorvastatin reduced bone formation, cellular proliferation, and Lrp5/b-catenin protein levels in the valves, which suggested that hypercholesterolaemic aortic valve calcification in rabbits may be mediated by activation of the Lrp5/b-catenin signal-transduction mechanism. We also investigated whether apoptosis (programmed cell death) contribution is relevant as a mechanism of aortic valve degeneration. 20 New Zealand white rabbits were fed either a 1% cholesterol diet (n ¼ 8) or a normal diet (n ¼ 8) for 12 weeks, after which their aortic valves were dissected. Apoptosis was identified in valvular lesions by the TUNEL (TdT-mediated dutp-biotin nick end-labelling) technique, which was verified with electron microscopy. Computed morphometry was used to determine the number of apoptotic cells. Valves from hypercholesterolaemic rabbits showed increased apoptosis in their atherosclerotic layer compared with valves of control rabbits (P, ). Because apoptosis is increased in rabbit aortic valves during experimental hypercholesterolaemia, this process may contribute to the pathogenesis of valvular disease. Weiss et al. 21 published the first report of a predisposition towards spontaneous development of the full aortic valvular heart disease syndrome in a laboratory animal. This group showed that senescent mice with moderate hypercholesterolaemia were prone to develop AS and valvular heart disease, and that oxidative stress played a role in the development of the disease. The animal model used was the genetic knockout mouse, which lacks the gene for the LDL receptor (LDLr) and expresses only the receptor for the human apolipoprotein B-100 (LDLr 2/2 ApoB 100/100 ). This same genotype has been associated with the development of large human aortic intimal atheromata. Von Kossa staining of the aortic valve showed mineralisation in LDLr 2/2 ApoB 100/100 mice but not in control mice. Superoxide (shown as oxyethidium fluorescence), evidence of oxidative stress, was present in greater concentration in the LDLr 2/2 ApoB 100/100 mice with AS than in those without.
4 Update on the pathophysiology of aortic stenosis E7 Figure 2 Association of osteopontin and minimal valve calcification in a congenital bicuspid aortic valve that was replaced. Radiograph (A) of calcific deposits (bright white regions at the tip and base of the left leaflet); stained (B; alizarin red S) section of the calcified tip; low-power (C) and high-power (D) photomicrographs of the stained (antiosteopontin antibody) calcified tip. Reprinted with permission from Mohler et al. 16 Copyright & 1997 Lippincott Williams & Wilkins. Figure 3 Phenotype of calcified aortic valve obtained with reverse transcription polymerase chain reaction. There was an increase in mrna expression for all markers shown, except alkaline phosphatase. Norm, normal aortic valve; Calc, calcified aortic valve; GAPDH, glyceraldehyde-3-phosphate dehydrogenase. Reprinted with permission from Circulation. 17 Copyright & 2003 Lippincott Williams & Wilkins. Further evidence of endothelial dysfunction with oxidative stress and inflammation in the pathogenesis of cholesterol-initiated AS was provided by another of our studies of hypercholesterolaemic rabbits. 22 In this study, we assessed the effects of atorvastatin on endothelial nitric oxide synthase (enos) expression, serum nitrite concentration, and aortic valve calcification. Three groups of 16 rabbits each were fed a normal diet, a high-cholesterol (0.5%) diet, or a high-cholesterol diet plus atorvastatin for 3 months, after which valves were examined using enos immunostains and western blotting. Results showed lower serum concentrations of nitrite and higher serum concentrations of the inflammation marker high-sensitivity C-reactive protein in hypercholesterolaemic compared with normocholesterolaemic rabbits. Bone mineralisation was present in the aortic valves of the hypercholesterolaemic animals. Atorvastatin administration was associated with a reduction in oxidative stress, as indicated by higher serum nitrite concentrations in atorvastatin-treated rabbits (vs. those fed a high-cholesterol diet without statin administration). Charest et al. 23 reported further evidence of endothelial dysfunction associated with degenerative AS in human valves that had been surgically removed. In their study of 30 valves with AS and 20 normal aortic valves, investigators found normal valves to be avascular, whereas valves with degenerative AS contained blood vessels in specific areas. The secreted protein, acidic and rich in cysteine/osteonectin (SPARC), which is a protein involved in ossification, angiogenesis, and metalloproteinase production, was present in AS valves in mature blood vessels and in macrophages. To assess whether aortic valve atherosclerosis and early bone matrix expression occur secondary to experimental hypercholesterolaemia and that treatment with a statin can modify this transformation, we examined 16 male New Zealand white rabbits fed a normal diet (control), 16 fed a diet supplemented with cholesterol (cholesterol-fed animals), and 16 cholesterol-fed animals treated with atorvastatin for 8 weeks. 24 Osteoblast bone markers, including one for osteopontin, were determined by RT PCR. Rabbits rendered hypercholesterolaemic developed a proliferative atherosclerosis-like process in the aortic valve, with increased staining for macrophages as well as increased expression of osteopontin bone matrix expression; these were reduced in animals receiving atorvastatin (Figure 5). 24 Currently, there are a number of ongoing clinical trials testing the hypothesis that medical therapy can slow the progression of aortic valve disease. The most recent published study is RAAVE (Rosuvastatin Affecting Aortic Valve Endothelium), from Porto Portugal, which determined that earlier treatment with a statin is more efficacious in the prevention of progression of aortic valve stenosis than late treatment. 25 First clinical evidence In the RAAVE trial, we studied the prospective treatment of AS with rosuvastatin targeting serum LDL cholesterol. This treatment slowed progression of AS according to echocardiographic haemodynamic measurements and improved inflammatory biomarkers, providing initial
5 E8 N.M. Rajamannan Figure 4 Calcification and cartilage in human degenerative (myxomatous) mitral valves and calcified tricuspid and bicuspid aortic valves (25 magnification). (A) Alizarin red stain; (B) alcian blue stain; (C) microct scan; white area is calcification. Reprinted from J Am Coll Cardiol. 18 Copyright & 2006 with permission from the American College of Cardiology as published by Elsevier. Figure 5 Macrophage (upper row left) and osteopontin (lower row left) production shown by light microscopy (12.5 magnification). In each panel, the aortic valve leaflet is to the left of the aorta. Upper right row shows RT PCR with the total RNA from aortic valves for osteopontin, and lower row right shows these results normalised to GAPDH. Atorv, atorvastatin; Chol, cholesterol-fed; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; OPN, osteopontin; RT PCR, reverse transcription polymerase chain reaction. Reprinted with permission from Circulation. 24 Copyright & 2002 Lippincott Williams & Wilkins. clinical evidence for targeted therapy in patients with asymptomatic AS. The study s aim was to assess the effects of rosuvastatin on the haemodynamic progression and inflammatory markers of AS by treating LDL cholesterol in patients with AS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines 26 for 1 year. The RAAVE investigators performed an open-label, prospective study evaluating 118 consecutive patients with asymptomatic moderate AS (age years; 56 men and 62 women) with and without rosuvastatin according to the NCEP ATP III guidelines. 26 Echocardiographic parameters
6 Update on the pathophysiology of aortic stenosis E9 and serum markers for high-sensitivity C-reactive protein, interleukin-6 (IL-6), and CD40 were measured at baseline and every 6 months for 1 year. A total of 65 patients (55.1%) with an elevated LDL cholesterol ( mg/dl), aortic valve velocity (AVV) of m/s, and AVA of cm 2 received rosuvastatin 20 mg/day, compared with 53 (44.9%) patients having a normal LDL cholesterol ( mg/dl), an AVV of m/s, and an AVA of cm 2 who did not receive a statin. During a mean follow-up of weeks, the decrease in AVA was cm 2 in the non-statin group compared with cm 2 in the statin treatment group (P ¼ 0.059). The change in peak AVV was m/s in the statin vs m/s in the non-statin treatment group (P ¼ 0.016). There were statistically significant improvements in all serum markers in the statin group. Prospective treatment of moderate AS with rosuvastatin targeting serum LDL cholesterol slowed progression of peak AVV and improved inflammatory biomarkers, providing the first clinical evidence for targeted therapy in asymptomatic moderate-to-severe AS. 25 The first prospective randomised study of statins for AS published (SALTIRE: Scottish Aortic Stenosis and Lipid Lowering Trial) found that high-dose atorvastatin did not halt or significantly slow disease progression (or induce disease regression) compared with placebo; however, patients had evidence of advanced AS at baseline. 27 Other studies, such as the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS), 28 ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin), 29 and STOP-AS 30 trials, are further evaluating the effects of statins and other lipid-modifying therapies in patients with aortic valve disease. Summary Calcific AS remains the leading indication for surgical valve replacement. The pathophysiology of calcific AS is no longer considered to be a largely passive process but is rather understood to be an active one, with initiating factors and mechanisms of progression that are broadly similar to those of atherosclerosis in coronary and other arteries. Risk factors shared by calcific AS and atherosclerosis include hypertension, elevated LDL cholesterol, male gender, smoking, and diabetes mellitus. Calcific AS often develops in persons with atherosclerosis, as indicated (especially in the elderly) by an increased risk of deaths from cardiovascular disease in patients with calcific AS. In addition, calcific AS and atherosclerosis may coexist in persons with homozygous familial hypercholesterolaemia. Animal studies have shown that, as in atherosclerosis, experimental hypercholesterolaemia initiates endothelial dysfunction in aortic valves, with upregulation of oxidative stress and inflammatory processes leading to plaque formation, as well as a switch to an osteogenic phenotype with valve mineralisation. Evidence for the presence of endothelial dysfunction in the development of calcific AS has been demonstrated in human valves that have been removed surgically. In animal studies of AS, administration of a statin blunted hypercholesterolaemia-induced valve mineralisation and cellular proliferation. This background on AS pathophysiology helps to set the stage for potential benefits of LDL cholesterollowering therapy in humans, with the hope that medical therapy may be able to prevent or delay the need for valve replacement. Clinical implications Hypercholesterolaemia may be an important factor in the initiation and progression of AS, and statins may inhibit the induction of this process in animals. If the human aortic valve undergoes a pathophysiological process initiated by hypercholesterolaemia with oxidative modification of cholesterol, as suggested by the studies described earlier, medical therapy might help to decelerate AS progression. Conclusions The leading indication for surgical valve replacement is calcific AS. Once considered a passive process, the pathophysiology of calcific AS is now understood to be active, with initiating factors and mechanisms of progression that are broadly similar to those of atherosclerosis in coronary and other arteries. Animal studies have shown that experimental hypercholesterolaemia initiates endothelial dysfunction in valves, with upregulation of oxidative stress and inflammatory processes leading to plaque formation and bone-like valve mineralisation. Evidence of endothelial dysfunction in the development of calcific AS in humans has been obtained through the study of surgically excised aortic valves. Appreciation that calcific AS reflects the results of active biological processes has led to the consideration that these processes may be amenable to elimination or slowing by pharmacotherapeutic intervention, potentially avoiding or at least postponing the need for valve replacement. Acknowledgements Assistance in the preparation of the manuscript was provided by Rete Biomedical Communications Corp. (Ridgewood, NJ, USA). Conflict of interest: none declared. Funding This work was completed with the support of an American Heart Association Grant-in-Aid ( Z) and a grant from the National Institute of Health (5K08HL , 1R01HL A1). The author is an inventor on a patent for the use of statins in the degeneration of aortic valve disease. This patent is owned by the Mayo Clinic, and the author does not receive any royalties from this patent. This work was received from the Merck/Schering-Plough Joint Venture.
7 E10 N.M. Rajamannan References 1. Rajamannan NM, Bonow RO, Rahimtoola SH. Calcific aortic stenosis: an update. Nat Clin Pract Cardiovasc Med 2007;4: Ross J Jr, Braunwald E. Aortic stenosis. Circulation 1968;38(Suppl. 1): Bonow RO, Carabello BA, Kanu C, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O Gara PT, O Rourke RA, Otto CM, Shah PM, Shanewise JS. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 2006;114:e84 e Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskamp F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A, for the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Guidelines on the management of valvular heart disease. Eur Heart J 2007; 28: Society of Thoracic Surgeons. Adult CV Surgery National Database, Spring 2007 Executive Summary. The Society of Thoracic Surgeons. (21 December 2007). 6. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM, for the Cardiovascular Health Study. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997;29: Aronow WS, Ahn C, Kronzon I, Goldman ME. Association of coronary risk factors and use of statins with progression of mild valvular aortic stenosis in older persons. Am J Cardiol 2001;88: Palta S, Pai AM, Gill KS, Pai RG. New insights into the progression of aortic stenosis: implications for secondary prevention. Circulation 2000;101: Peltier M, Trojette F, Sarano ME, Grigioni F, Slama MA, Tribouilloy CM. Relation between cardiovascular risk factors and nonrheumatic severe calcific aortic stenosis among patients with a three-cuspid aortic valve. Am J Cardiol 2003;91: Chui MC, Newby DE, Panarelli M, Bloomfield P, Boon NA. Association between calcific aortic stenosis and hypercholesterolemia: is there a need for a randomized controlled trial of cholesterol-lowering therapy? Clin Cardiol 2001;24: Pohle K, Maffert R, Ropers D, Moshage W, Stilianakis N, Daniel WG, Achenbach S. Progression of aortic valve calcification: association with coronary atherosclerosis and cardiovascular risk factors. Circulation 2001;104: Sprecher DL, Schaefer EJ, Kent KM, Gregg RE, Zech LA, Hoeg JM, McManus B, Roberts WC, Brewer HB Jr. Cardiovascular features of homozygous familial hypercholesterolemia: analysis of 16 patients. Am J Cardiol 1984;54: Rajamannan NM, Edwards WD, Spelsberg TC. Hypercholesterolemic aortic-valve disease. N Engl J Med 2003;349: Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999;341: O Brien KD, Reichenbach DD, Marcovina SM, Kuusisto J, Alpers CE, Otto CM. Apolipoproteins B, (a), and E accumulate in the morphologically early lesion of degenerative valvular aortic stenosis. Arterioscler Thromb Vasc Biol 1996;16: Mohler ER III, Adam LP, McClelland P, Graham L, Hathaway DR. Detection of osteopontin in calcified human aortic valves. Arterioscler Thromb Vasc Biol 1997;17: Rajamannan NM, Subramaniam M, Rickard D, Stock SR, Donovan J, Springett M, Orszulak T, Fullerton DA, Tajik AJ, Bonow RO, Spelsberg T. Human aortic valve calcification is associated with an osteoblast phenotype. Circulation 2003;107: Caira FC, Stock SR, Gleason TG, McGee EC, Huang J, Bonow RO, Spelsberg TC, McCarthy PM, Rahimtoola SH, Rajamannan NM. Human degenerative valve disease is associated with up-regulation of low-density lipoprotein receptor-related protein 5 receptor-mediated bone formation. J Am Coll Cardiol 2006;47: Rajamannan NM, Subramaniam M, Caira F, Stock SR, Spelsberg TC. Atorvastatin inhibits hypercholesterolemia-induced calcification in the aortic valves via the Lrp5 receptor pathway. Circulation 2005; 112(Suppl. 9):I229 I Rajamannan NM, Sangiorgi G, Springett M, Arnold K, Mohacsi T, Spagnoli LG, Edwards WD, Tajik AJ, Schwartz RS. Experimental hypercholesterolemia induces apoptosis in the aortic valve. J Heart Valve Dis 2001;10: Weiss RM, Ohashi M, Miller JD, Young SG, Heistad DD. Calcific aortic valve stenosis in old hypercholesterolemic mice. Circulation 2006; 114: Rajamannan NM, Subramaniam M, Stock SR, Stone NJ, Springett M, Ignatiev KI, McConnell JP, Singh RJ, Bonow RO, Spelsberg TC. Atorvastatin inhibits calcification and enhances nitric oxide synthase production in the hypercholesterolaemic aortic valve. Heart 2005;91: Charest A, Pepin A, Shetty R, Cote C, Voisine P, Dagenais F, Pibarot P, Mathieu P. Distribution of SPARC during neovascularisation of degenerative aortic stenosis. Heart 2006;92: Rajamannan NM, Subramaniam M, Springett M, Sebo TC, Niekrasz M, McConnell JP, Singh RJ, Stone NJ, Bonow RO, Spelsberg TC. Atorvastatin inhibits hypercholesterolemia-induced cellular proliferation and bone matrix production in the rabbit aortic valve. Circulation 2002;105: Moura LM, Ramos SF, Zamorano JL, Barros IM, Azevedo LF, Rocha-Goncalves F, Rajamannan N. Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis. JAm Coll Cardiol 2007;49: National Cholesterol Education Program. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB, Boon NA. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med 2005; 352: Rossebø AB, Pedersen TR, Allen C, Boman K, Chambers J, Egstrup K, Gerdts E, Gohlke-Barwolf C, Holme I, Kesaniemi VA, Malbecq W, Nienaber C, Ray S, Skjaerpe T, Wachtell K, Willenheimer R. Design and baseline characteristics of the simvastatin and ezetimibe in aortic stenosis (SEAS) study. Am J Cardiol 2007;99: Chan KL, Teo K, Tam J, Dumesnil JG. Rationale, design, and baseline characteristics of a randomized trial to assess the effect of cholesterol lowering on the progression of aortic stenosis: the Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin (ASTRONOMER) trial. Am Heart J 2007;153: Cleveland Clinic. The effect of Statin Therapy (Atorvastatin) on the Progression of Calcific Valvular Aortic Stenosis (STOP-AS). Clinical- Trials.gov. (2 February 2008).
Calcific aortic stenosis is the third most common cause of aortic valve disease in developed
Valve disease CALCIFIC AORTIC STENOSIS: FROM BENCH TO THE BEDSIDE EMERGING CLINICAL AND CELLULAR CONCEPTS See end of article for authors affiliations c AETIOLOGY Correspondence to: Nalini M Rajamannan,
More informationAortic stenosis (AS) is common with the aging population.
New Insights Into the Progression of Aortic Stenosis Implications for Secondary Prevention Sanjeev Palta, MD; Anita M. Pai, MD; Kanwaljit S. Gill, MD; Ramdas G. Pai, MD Background The risk factors affecting
More informationJournal of the American College of Cardiology Vol. 47, No. 8, by the American College of Cardiology Foundation ISSN /06/$32.
Journal of the American College of Cardiology Vol. 47, No. 8, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.02.040
More informationFor unclear reasons, only about 40% of patients with calcific aortic stenosis also have coronary
Αθηροσκλήρωση και ασβεστοποιός στένωση της αορτικής βαλβίδας. Οµοιότητες και διαφορές Ν. Μεζίλης Κλινική «Άγιος Λουκάς» Ασβεστοποιός στένωση της αορτικής βαλβίδας: Μία ακόµα µορφή αθηρωµάτωσης; Some observations
More informationVALVULO-METABOLIC RISK IN AORTIC STENOSIS
January 2008 (Vol. 1, Issue 1, pages 21-25) VALVULO-METABOLIC RISK IN AORTIC STENOSIS By Philippe Pibarot, DVM, PhD, FACC, FAHA Groupe de Recherche en Valvulopathies (GRV), Hôpital Laval Research Centre
More informationCOMPARISON OF ANTHROPOMETRIC MEASUREMENT AND TOTAL CHOLESTEROL IN CALCIFIC AORTIC STENOSIS
COMPARISON OF ANTHROPOMETRIC MEASUREMENT AND TOTAL CHOLESTEROL IN CALCIFIC AORTIC STENOSIS Erum Afaq*, Rubina Ghani**, Muhammad Kashif Nisar*** *Assistant Professor, Physiology, Liaquat National Hospital
More informationAtorvastatin Inhibits Hypercholesterolemia-Induced Cellular Proliferation and Bone Matrix Production in the Rabbit Aortic Valve
Atorvastatin Inhibits Hypercholesterolemia-Induced Cellular Proliferation and Bone Matrix Production in the Rabbit Aortic Valve Nalini M. Rajamannan, MD; Malayannan Subramaniam, PhD; Margaret Springett;
More informationA ortic stenosis is the most common adult
729 HEART REVIEW Emerging medical treatments for aortic stenosis: statins, angiotensin converting enzyme inhibitors, or both? D E Newby, S J Cowell, N A Boon... Aortic stenosis is the most common adult
More informationPresented by Terje R. Pedersen Oslo Disclosure: Research grants and/or speaker- / consulting fees from Merck, MSP, Astra-Zeneca, Pfizer
Presented by Terje R. Pedersen Oslo Disclosure: Research grants and/or speaker- / consulting fees from Merck, MSP, Astra-Zeneca, Pfizer Patients Randomized by Country 187 UK n=187 Norway n=425 Finland
More informationA High Fat/High Carbohydrate Diet Induces Aortic Valve Disease in C57BL/6J Mice
Journal of the American College of Cardiology Vol. 47, No. 4, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.09.049
More informationDisclosures Nothing to disclose
Aortic Valve Disease Illustrative Cases December 8, 2009 David Stultz, MD, FACC Southwest Cardiology, Inc Handout available at http://www.drstultz.com Disclosures Nothing to disclose Objectives Understand
More information: mm 86 mm EF mm
37 Vol. 35, pp. 37 42, 2007 2 3 : 9 6 22 68 40 2003 4 Ejection fraction: EF44 IV 70 mm 86 mm EF46 6 24 mm 4 mm EF 80 60 mm 70 mm Aortic Regurgitation: AR 2 3 AR Aortic Valve Replacement: AVR AR 38 : 68
More informationCalcific aortic stenosis: same old story?
Age and Ageing 2004; 33: 538 544 Age and Ageing Vol. 33 No. 6 British Geriatrics Society 2004; all rights reserved doi:10.1093/ageing/afh175 Published electronically 12 August 2004 REVIEWS Calcific aortic
More informationAnti-inflammatory effect of atorvastatin in patients with aortic sclerosis or mild aortic stenosis independent of hypercholesterolemia
Pharmacological Reports 2010, 62, 1250 1254 ISSN 1734-1140 Copyright 2010 by Institute of Pharmacology Polish Academy of Sciences Short communication Anti-inflammatory effect of atorvastatin in patients
More informationCopyright by ICR Publishers 2006
Lower Serum Calcium Levels are Associated with Greater Calcium Hydroxyapatite Deposition in Native Aortic Valves of Male Patients with Severe Calcific Aortic Stenosis Jan R. Ortlepp 1, Manuela Pillich
More informationAlthough the leading cause of aortic stenosis (AS)
Aortic stenosis (AS) is a narrowing or obstruction of the aortic valve and is the third most prevalent form of cardiovascular disease in the Western world after hypertension and coronary artery disease.
More informationCopyright by ICR Publishers 2010
The Association of Heart Valve Diseases with Coronary Artery Dominance Gwilym M. Morris 1, Anthony L. Innasimuthu 2, Jonathan P. Fox 3, Raphael A. Perry 4 1 Division of Cardiovascular and Endocrine Sciences,
More informationVascular Tumor Necrosis Factor-alpha Gene Expression in Human Aortic Valve Calcification
Vascular Tumor Necrosis Factor-alpha Gene Expression in Human Aortic Valve Expression of TNF-α in Calcified Aortic Valves Javier Donate-Correa 1, Rafael Martínez-Sanz 2, Mercedes Muros-de-Fuentes 3, Carmen
More informationT he detection of an ejection systolic murmur
1389 REVIEW Aortic sclerosis: not an innocent murmur but a marker of increased cardiovascular risk A K Nightingale, J D Horowitz... The detection of an ejection systolic murmur in the aortic valve region
More informationAortic valve stenosis has a prevalence of 2% to 7% in the
Progression of Aortic Valve Calcification Association With Coronary Atherosclerosis and Cardiovascular Risk Factors Karsten Pohle, MD; Ralph Mäffert, MD; Dieter Ropers, MD; Werner Moshage, MD; Nicolaos
More informationReducing low-density lipoprotein cholesterol treating to target and meeting new European goals
European Heart Journal Supplements (2004) 6 (Supplement A), A12 A18 Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals University of Sydney, Sydney, NSW, Australia
More informationWith the striking decrease in the prevalence of rheumatic
Aortic Valve Calcification Determinants and Progression in the Population David Messika-Zeitoun, Lawrence F. Bielak, Patricia A. Peyser, Patrick F. Sheedy, Stephen T. Turner, Vuyisile T. Nkomo, Jerome
More informationAssociation of Cholesterol Levels, Hydroxymethylglutaryl Coenzyme-A Reductase Inhibitor Treatment, and Progression of Aortic Stenosis in the Community
Journal of the American College of Cardiology Vol. 40, No. 10, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02496-8
More informationORIGINAL INVESTIGATION. Angiotensin-Converting Enzyme Inhibitors and Change in Aortic Valve Calcium
ORIGINAL INVESTIGATION Angiotensin-Converting Enzyme Inhibitors and Change in Aortic Valve Calcium Kevin D. O Brien, MD; Jeffrey L. Probstfield, MD; Michael T. Caulfield, MD; Khurram Nasir, MD, MPH; Junichiro
More informationArteriosclerosis & Atherosclerosis
Arteriosclerosis & Atherosclerosis Arteriosclerosis = hardening of arteries = arterial wall thickening + loss of elasticity 3 types: -Arteriolosclerosis -Monckeberg medial sclerosis -Atherosclerosis Arteriosclerosis,
More informationHow would you manage Ms. Gold
How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56
More informationDeterminants of progression of aortic valve stenosis and outcome of adverse events in hemodialysis patients
Journal of Cardiology (2012) 59, 78 83 Available online at www.sciencedirect.com j our na l ho me page: www.elsevier.com/locate/jjcc Original article Determinants of progression of aortic valve stenosis
More informationCARDIAC PHYSIOLOGIST LED AORTIC STENOSIS SURVEILLANCE CLINIC
CARDIAC PHYSIOLOGIST LED AORTIC STENOSIS SURVEILLANCE CLINIC Background Aortic stenosis is the commonest form of valvular heart disease in the UK Asymptomatic patients with mild AS make up a significant
More informationManagement of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France
Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France Background Aortic stenosis (AS) is the most frequent valve disease among referred
More informationAortic stenosis (AS) is a common condition of the elderly,
Evaluation of Patients With Severe Symptomatic Aortic Stenosis Who Do Not Undergo Aortic Valve Replacement The Potential Role of Subjectively Overestimated Operative Risk David S. Bach, MD; Derrick Siao,
More informationAortic sclerosis not an innocent murmur but a marker of increased cardiovascular risk
Heart Online First, published on March 29, 2005 as 10.1136/hrt.2004.057117 Aortic sclerosis not an innocent murmur but a marker of increased cardiovascular risk Angus K Nightingale, John D Horowitz Department
More informationValvular Guidelines: The Past, the Present, the Future
Valvular Guidelines: The Past, the Present, the Future Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital Editor-in-Chief,
More informationWorldwide rheumatic fever is the most common cause of valve disease. In industrialized areas, valvular disease of old age predominates
Michael Sumners DO Epidemiology Worldwide rheumatic fever is the most common cause of valve disease In industrialized areas, valvular disease of old age predominates Calcific aortic stenosis Functional
More informationThe inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema
The inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema Dept Cardiology, Leiden University Medical Center, Leiden,
More informationCalcific aortic valve disease (CAVD) encompasses the
Special Report Calcific Aortic Valve Disease: Not Simply a Degenerative Process A Review and Agenda for Research From the National Heart and Lung and Blood Institute Aortic Stenosis Working Group Executive
More informationValvular Heart Disease
Valvular Heart Disease Roman M. Sniecinski, MD, FASE Associate Professor of Anesthesiology Emory University School of Medicine Learning Objectives Review the major pathophysiology of the most common heart
More informationSevere Asymptomatic Aortic Stenosis
Severe Asymptomatic Aortic Stenosis The Clinician s Perspective Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital
More informationCoronary Artery Calcium Score
Coronary Artery Calcium Score August 19, 2014 by Axel F. Sigurdsson MD 174 Comments essential for living organisms. Calcium is a chemical element that is Most of the calcium within the human body is found
More informationCLINICAL OUTCOME Vs SURROGATE MARKER
CLINICAL OUTCOME Vs SURROGATE MARKER Statin Real Experience Dr. Mostafa Sherif Senior Medical Manager Pfizer Egypt & Sudan Objective Difference between Clinical outcome and surrogate marker Proper Clinical
More informationAortic Valve Stenosis: Medical Treatment, Still in the Pipeline?
Aortic Valve Stenosis: Medical Treatment, Still in the Pipeline? Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Research Group in Valvular Heart Diseases Canada Research Chair in Valvular Heart Diseases
More informationThe Transcatheter Aortic Valve Replacement (TAVR)Program at Southcoast Health. Adam J. Saltzman, MD Cardiovascular Care Center
The Transcatheter Aortic Valve Replacement (TAVR)Program at Southcoast Health Adam J. Saltzman, MD Cardiovascular Care Center Southcoast Health Disclosures Edwards Lifesciences: speaking honorarium Outline
More informationShahbudin H. Rahimtoola MB, FRCP, MACP, MACC, FESC, D.Sc. (Hon.)
Shahbudin H. Rahimtoola MB, FRCP, MACP, MACC, FESC, D.Sc. (Hon.) DISCLOSURE As Editor, Current Problems in Cardiology Elsevier Honoraria for educational lectures from: American College of Cardiology Foundation;
More informationHydroxymethylglutaryl Coenzyme-A Reductase Inhibitors Delay the Progression of Rheumatic Aortic Valve Stenosis
Journal of the American College of Cardiology Vol. 53, No. 20, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.01.064
More informationTreatment of Atherosclerosis in 2007
Treatment of Atherosclerosis in 2007 Szilard Voros, M.D. Medical Director Cardiovascular MR and CT Piedmont Hospital, Piedmont Hospital Our Paradigm Genotype Phenotype Environment Atherosclerotic Disease
More informationAortic Regurgitation and Aortic Aneurysm - Epidemiology and Guidelines -
Reconstruction of the Aortic Valve and Root - A Practical Approach - Aortic Regurgitation and Aortic Aneurysm Wednesday 14 th September - 9.45 Practice must always be founded on sound theory. Leonardo
More informationReview of guidelines for management of dyslipidemia in diabetic patients
2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University
More informationSTATINS FOR PAD Long - term prognosis
STATINS FOR PAD Long - term prognosis Prof. Pavel Poredos, MD, PhD Department of Vascular Disease University Medical Centre Ljubljana Slovenia DECLARATION OF CONFLICT OF INTEREST No conflict of interest
More informationJournal of the American College of Cardiology Vol. 44, No. 9, by the American College of Cardiology Foundation ISSN /04/$30.
Journal of the American College of Cardiology Vol. 44, 9, 2004 2004 by the American College of Cardiology Foundation ISSN 0735-1097/04/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2004.04.062 Relation
More informationEzetimibe and SimvastatiN in Hypercholesterolemia EnhANces AtherosClerosis REgression (ENHANCE)
Ezetimibe and SimvastatiN in Hypercholesterolemia EnhANces AtherosClerosis REgression (ENHANCE) Thomas Dayspring, MD, FACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2062-8 Program Prior Authorization/Medical Necessity Medication Praluent (alirocumab) P&T Approval Date 5/2015, 8/2015, 9/2015,
More informationThe New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk
The New Gold Standard for Lipoprotein Analysis Advanced Testing for Cardiovascular Risk Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Evolution of Lipoprotein Testing
More informationAortic Valve Sclerosis and Aortic Atherosclerosis: Different Manifestations of the Same Disease? Insights From a Population-Based Study
Journal of the American College of Cardiology Vol. 38, No. 3, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(01)01422-X Aortic
More informationCurrent Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD
Current Cholesterol Guidelines and Treatment of Residual Risk J. Peter Oettgen, MD Associate Professor of Medicine Harvard Medical School Director, Preventive Cardiology Beth Israel Deaconess Medical Center
More informationAddressing Vascular Plaque Ruptures
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-penn-medicine/addressing-vascularplaque-ruptures/3131/
More informationAortic stenosis (AS) is a major cause of cardiovascular. Valvular Aortic Stenosis in the Elderly REVIEW ARTICLE. Wilbert S. Aronow, MD, FACC, FAHA
REVIEW ARTICLE Wilbert S. Aronow, MD, FACC, FAHA Abstract: Elderly patients with valvular aortic stenosis have an increased prevalence of coronary risk factors, of coronary artery disease, and evidence
More informationVascular disease. Structural evaluation of vascular disease. Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital
Vascular disease. Structural evaluation of vascular disease Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital resistance vessels : arteries
More informationThe aorta is an integral part of the cardiovascular system and should not be considered as just a conduit for blood supply from the heart to the
The aorta is an integral part of the cardiovascular system and should not be considered as just a conduit for blood supply from the heart to the limbs and major organs. A range of important pathologies
More informationPCSK9 Agents Drug Class Prior Authorization Protocol
PCSK9 Agents Drug Class Prior Authorization Protocol Line of Business: Medicaid P & T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review of medical
More informationFamilial hypercholesterolaemia in children and adolescents
Familial hypercholesterolaemia in children and adolescents Rationale and recommendations for early identification and treatment European Atherosclerosis Society Consensus Panel Slide deck adapted from:
More informationEffects of Kidney Disease on Cardiovascular Morbidity and Mortality
Effects of Kidney Disease on Cardiovascular Morbidity and Mortality Joachim H. Ix, MD, MAS Assistant Professor in Residence Division of Nephrology University of California San Diego, and Veterans Affairs
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2063-8 Program Prior Authorization/Medical Necessity Medication Repatha (evolocumab) P&T Approval Date 5/2015, 9/2015, 11/2015,
More informationAdult Cardiac Surgery
Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan Adult Cardiac Surgery: Ischemic Heart Disease
More informationData Alert. Vascular Biology Working Group. Blunting the atherosclerotic process in patients with coronary artery disease.
1994--4 Vascular Biology Working Group www.vbwg.org c/o Medical Education Consultants, LLC 25 Sylvan Road South, Westport, CT 688 Chairman: Carl J. Pepine, MD Eminent Scholar American Heart Association
More informationCoronary heart disease
1 of 9 12/30/2012 10:58 PM PubMed Health. A service of the National Library of Medicine, National Institutes of Health. A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011. Coronary heart disease
More informationLIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A 2 : EFFECTS OF LOW DENSITY LIPOPROTEIN APHERESIS
LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A 2 : EFFECTS OF LOW DENSITY LIPOPROTEIN APHERESIS Patrick M. Moriarty, M.D., FACP, Director, Atherosclerosis and LDL-Apheresis Center, University of Kansas Medical
More informationSevere symptomatic aortic stenosis is associated with a
Valvular Heart Disease Natural History of Very Severe Aortic Stenosis Raphael Rosenhek, MD; Robert Zilberszac; Michael Schemper, PhD; Martin Czerny, MD; Gerald Mundigler, MD; Senta Graf, MD; Jutta Bergler-Klein,
More informationCalcium is a chemical element that is essential for living organisms.
1 of 8 9/28/2015 9:04 AM Home About me Health and Nutrition Diet General Health Heart Disease August 19, 2014 By Axel F. Sigurdsson MD 259 Comments Like Share 82 Calcium is a chemical element that is essential
More informationZuhier Awan, MD, PhD, FRCPC
Metabolism, Atherogenic Properties and Agents to Reduce Triglyceride-Rich Lipoproteins (TRL) The Fifth IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 8-11, 2019 Zuhier
More informationNew Guidelines in Dyslipidemia Management
The Fourth IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 2018 New Guidelines in Dyslipidemia Management Dr. Khalid Al-Waili, MD, FRCPC, DABCL Senior Consultant Medical
More informationCottrell Memorial Lecture. Has Reversing Atherosclerosis Become the New Gold Standard in the Treatment of Cardiovascular Disease?
Cottrell Memorial Lecture Has Reversing Atherosclerosis Become the New Gold Standard in the Treatment of Cardiovascular Disease? Stephen Nicholls MBBS PhD @SAHMRI_Heart Disclosures Research support: AstraZeneca,
More informationHypertension in Aortic Valve Disease
Hypertension in Aortic Valve Disease Hanna M. Nosseir MRCP, FRCP Head of Cardiology department Galaa Military Medical Complex Aortic stenosis: Introduction Arterial hypertension and aortic stenosis are
More informationThe new guidelines issued in PRESENTATIONS... Future Outlook: Changing Perspectives on Best Practice
... PRESENTATIONS... Future Outlook: Changing Perspectives on Best Practice Based on a presentation by Daniel J. Rader, MD Presentation Summary The guidelines recently released by the National Cholesterol
More informationSTATIN UTILIZATION MANAGEMENT CRITERIA
STATIN UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: HMG Co-A Reductase Inhibitors & Combinations Agents which require prior review: Advicor (niacin extended-release/lovastatin) Crestor (rosuvastatin)(5mg,10mg,
More informationCase Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer
Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32,
More informationDrug Class Monograph
Drug Class Monograph Class: Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitor Drugs: Praluent (alirocumab), Repatha (evolocumab) Line of Business: Medi-Cal Effective Date: February 17, 2016
More informationBicuspid Aortic Valve: Only Valvular Disease? Artur Evangelista
Bicuspid Aortic Valve: Only Valvular Disease? Artur Evangelista Bicuspid aortic valve BAV is not only a valvulogenesis disorder but also represent coexisting aspects of a genetic disorder of the aorta
More informationBICUSPID AORTIC VALVE DISEASE. Northwestern s Bluhm Cardiovascular Institute Center for Heart Valve Disease
BICUSPID AORTIC VALVE DISEASE Northwestern s Bluhm Cardiovascular Institute Center for Heart Valve Disease Martha and Richard Melman Family Bicuspid Aortic Valve Program BICUSPID AORTIC VALVE What is Bicuspid
More informationCalcific aortic valve disease is identified by thickening
Pathogenesis of Calcific Aortic Valve Disease A Disease Process Comes of Age (and a Good Deal More) Kevin D. O Brien Background Over the past 10 to 15 years, calcific aortic valve disease, which includes
More informationCalcification of Porcine Aortic Valvular Interstitial Cells
Calcification of Porcine Aortic Valvular Interstitial Cells Liwen Gu 1,2* Supervisor: Craig A. Simmons 1 Department of Engineering Science, 2 Institute of Biomaterials and Biomedical Engineering, University
More informationAortic Stenosis: UPDATE Anjan Sinha, MD Krannert Institute of Cardiology
Aortic Stenosis: UPDATE 2010 Anjan Sinha, MD Krannert Institute of Cardiology None Disclosures 67-Year-Old Male Dyspnea and angina Class III heart failure No PND or orthopnea 3/6 late peak SEM Diminished
More informationLipid Metabolism in Familial Hypercholesterolemia
Lipid Metabolism in Familial Hypercholesterolemia Khalid Al-Rasadi, BSc, MD, FRCPC Head of Biochemistry Department, SQU Head of Lipid and LDL-Apheresis Unit, SQUH President of Oman society of Lipid & Atherosclerosis
More informationChanging lipid-lowering guidelines: whom to treat and how low to go
European Heart Journal Supplements (2005) 7 (Supplement A), A12 A19 doi:10.1093/eurheartj/sui003 Changing lipid-lowering guidelines: whom to treat and how low to go C.M. Ballantyne Section of Atherosclerosis,
More informationThe Value of Percutaneous Coronary Intervention in Aortic Valve Stenosis with Coronary Artery Disease
The American Journal of Medicine (2007) 120, 185.e7-185.e13 BRIEF OBSERVATION The Value of Percutaneous Coronary Intervention in Aortic Valve Stenosis with Coronary Artery Disease Ronny Alcalai, MD, a
More informationSpotlight on Valvular Heart Disease Guidelines
Spotlight on Valvular Heart Disease Guidelines Aortic Valve Disease Raphael Rosenhek Department of Cardiology Medical University of Vienna Palermo, April 26 th 2018 1998 2002 2006 2007 2008 2012 2014 2017
More informationIt is the policy of health plans affiliated with PA Health & Wellness that Vytorin is medically necessary when the following criteria are met:
Clinical Policy: Ezetimibe and Simvastatin (Vytorin) Reference Number: PA.CP.PMN.77 Effective Date: 02.01.17 Last Review Date: 07.18 Revision Log Description Ezetimibe/simvastatin (Vytorin ) contains ezetimibe,
More information조현재 서울대학교병원순환기내과, 심혈관연구실,
Molecular Mechanism of Vascular Calcification 2010. 4. 17. 조현재 서울대학교병원순환기내과, 심혈관연구실, 서울대학교병원심혈관센터 Vascular calcification : clinical hurdles Vascular calcification : clinical significance! Clinical consequences
More informationRecombinant apolipoprotein A-I Milano rapidly reverses aortic valve stenosis and decreases leaflet inflammation in an experimental rabbit model
European Heart Journal (2010) 31, 2049 2057 doi:10.1093/eurheartj/ehq064 BASIC SCIENCE Recombinant apolipoprotein A-I Milano rapidly reverses aortic valve stenosis and decreases leaflet inflammation in
More informationThe timing of aortic valve surgery is
Heart 2000;84:211 218 VALVE DISEASE the prudent physician will evaluate and treat conventional coronary risk factors. Timing of aortic valve surgery Catherine M Otto Division of Cardiology, University
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationHYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016
HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016 NOTHING TO DISCLOSE I, Nicole Slater, have no actual or potential conflict
More informationValue of neutrophil to lymphocyte ratio as a predictor of mortality in patients undergoing aortic valve replacement
Original Article Value of neutrophil to lymphocyte ratio as a predictor of mortality in patients undergoing aortic valve replacement Mirette Habib 1, Mohammad Thawabi 2, Amer Hawatmeh 2, Habib Habib 1,
More informationLow-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies
Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies A Consensus Statement from the European Atherosclerosis Society
More informationAortic Stenosis and Perioperative Risk With Non-cardiac Surgery
Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery Aortic stenosis (AS) is characterized as a high-risk index for cardiac complications during non-cardiac surgery. A critical analysis of old
More informationNormal blood vessels A= artery V= vein
Normal blood vessels A= artery V= vein Artery (A) versus vein (V) ARTERIOSCLEROSIS Arteriosclerosis ="hardening of the arteries" arterial wall thickening and loss of elasticity. Three patterns are recognized,
More informationLIPIDS AND CHOLESTEROL - RISK FACTORS TO A POLICE UNIT FROM BRASOV
Bulletin of the Transilvania University of Braşov Series VI: Medical Sciences Vol. 4 (53) No. 2-2011 LIPIDS AND CHOLESTEROL - RISK FACTORS TO A POLICE UNIT FROM BRASOV C. DOBRESCU 1 I. MOLEAVIN 1 Abstract:
More information( Diabetes mellitus, DM ) ( Hyperlipidemia ) ( Cardiovascular disease, CVD )
005 6 69-74 40 mg/dl > 50 mg/dl) (00 mg/dl < 00 mg/dl(.6 mmol/l) 30-40% < 70 mg/dl 40 mg/dl 00 9 mg/dl fibric acid derivative niacin statin fibrate statin niacin ( ) ( Diabetes mellitus,
More informationHypercholesterolemia is a risk factor for bioprosthetic valve calcification and explantation
Hypercholesterolemia is a risk factor for bioprosthetic valve calcification and explantation Robert Saeid Farivar, MD, PhD Lawrence H. Cohn, MD Objective: There are pathophysiologic similarities between
More informationLow-density lipoprotein as the key factor in atherogenesis too high, too long, or both
Low-density lipoprotein as the key factor in atherogenesis too high, too long, or both Lluís Masana Vascular Medicine and Metabolism Unit. Sant Joan University Hospital. IISPV. CIBERDEM Rovira i Virgili
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationCoronary Artery Calcification
Coronary Artery Calcification Julianna M. Czum, MD OBJECTIVES CORONARY ARTERY CALCIFICATION Julianna M. Czum, MD Dartmouth-Hitchcock Medical Center 1. To review the clinical significance of coronary heart
More information