Pathophysiologic Mechanisms of Age – Related Aortic Valve Calcification

Aortic stenosis is the most common valvular lesion in Europe and North America [2]. As incidence of acute rheumatic fever has declined, calcific aortic stenosis (CAS) has become the most common indication for surgical valve replacement in the United States (Fig. 2) [3]. Regarding population aged>65 years, its incidence is 2-7% [2]. Interestingly, aortic sclerosis (aortic valve calcification without hemodynamic compromise) is present in more than 25% of patients older than age 65 years [5]. Recent studies provide evidence that atherosclerosis and CAS share common features in relation to risk factors and histopathologic lesions [3]. Moreover, histopathologic evidence suggests that early lesions in CAS are not just a result secondary to aging, but an active cellular process. Recent research implies that the classical “response to injury hypothesis”, initially described in atherosclerosis, seems to represent the cornerstone of pathophysiology [4].