Aortic Valve Sclerosis and Cardiovascular Risk

Definition and Prevalence

• Aortic sclerosis is defined as irregular valve thickening and calcification without obstruction to left ventricular outflow, and is present in approximately 25% of adults over 65 years of age, associated with multiple cardiovascular risk factors including age, male sex, hypertension, smoking, elevated LDL cholesterol, elevated lipoprotein(a), and diabetes mellitus 1, 2, 3, 4, 5

Cardiovascular Risk

• The American College of Cardiology and Circulation guidelines suggest that patients with aortic sclerosis have an approximately 50% increased risk of myocardial infarction and cardiovascular death compared to those with normal aortic valves, with this increased risk persisting even after adjusting for age, sex, known cardiovascular disease, and traditional cardiovascular risk factors 1, 2, 3, 4, 5

Risk Factor Modification

• The American College of Cardiology recommends aggressive management of all modifiable cardiovascular risk factors, including lipid management with statin therapy to target LDL cholesterol below 70 mg/dL 6
• Diabetes management is crucial as diabetes is a significant risk factor for aortic sclerosis 1, 2
• Smoking cessation is mandatory given the strong association between smoking and aortic sclerosis 1, 2

Surveillance Strategy

• Regular clinical follow-up is mandatory for all patients with aortic sclerosis, including monitoring for development of symptoms and serial echocardiography to assess for progression to stenosis 1, 2, 3, 4, 5