Aortic stenosis is the most common
valvular heart disease among adult subjects in western countries The current treatment for
aortic stenosis is aortic valve replacement. The possibility of a medical treatment that can slow the progression of
aortic stenosis is very fascinating and
statins have been tested to reduce the progression of degenerative
aortic stenosis (
DAS). The rationale for
statin treatment in
DAS has a deep pathophysiological substrate, in fact
inflammation and
lipid infiltration constitute the same histopathological pattern of both
aortic stenosis and
atherosclerosis and these two conditions have the same risk factors. Whether retrospective studies have shown some efficacy of
statins in halting the progression of
DAS, prospective trials have shown controversial results. A recently published large and randomized controlled trial SEAS found that
statins have no significant effect on the progression of
aortic stenosis, the ASTRONOMER, recently confirmed this data. The most plausible hypothesis is that
coronary artery disease and
DAS, have a common pathogenetic background and a distinct evolution due to different factors (mechanical stress, genetic factors, interaction between inflammatory cells and calcification mediators). Thus, treatment with
statins is not recommended in patients with valvular
aortic stenosis and without conventional indications to
lipid-lowering treatment.