title: Aortic stenosis: insights on pathogenesis and clinical implications.
abstract: Aortic stenosis (AS) is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active "atherosclerosis-like" pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces (such as mechanical stress, genetic factors and interaction between inflammation and calcification). The improved understanding presents potentially new therapeutic targets for preventing and inhibiting the development and progression of the disease. Furthermore, in clinical practice the management of AS patients implies the evaluation of generalized atherosclerotic manifestations (i.e., in the coronary and carotid arteries) even for prognostic reasons. In counselling elderly patients, the risk stratification should address individual frailty beyond the generic risk scores. In these regard, the co-morbidities, and in particular those linked to the global atherosclerotic burden, should be carefully investigated in order to define the risk/benefit ratio for invasive treatment strategies. We present a detailed overview of insights in pathogenesis of AS with possible practical implications.
authors: University Hospital, Paolo Giaccone, Palermo, Italy.
authors: Patrizia
authors: P
authors: Carità
authors: University Hospital, Paolo Giaccone, Palermo, Italy.
authors: Giuseppe
authors: G
authors: Coppola
authors: University Hospital, Paolo Giaccone, Palermo, Italy.
authors: Giuseppina
authors: G
authors: Novo
authors: Cardiac Unit, Buccheri La Ferla Hospital, Fatebenefratelli, Palermo, Italy.
authors: Giuseppa
authors: G
authors: Caccamo
authors: Centro Cardiologico Monzino, Milan, Italy.
authors: Marco
authors: M
authors: Guglielmo
authors: Cardiac Unit, Sant'Elia Hospital, Caltanissetta, Italy.
authors: Fabio
authors: F
authors: Balasus
authors: University Hospital, Paolo Giaccone, Palermo, Italy.
authors: Salvatore
authors: S
authors: Novo
authors: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors: Sebastiano
authors: S
authors: Castrovinci
authors: Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors: Marco
authors: M
authors: Moscarelli
authors: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors: Khalil
authors: K
authors: Fattouch
authors: University Hospital, Paolo Giaccone, Palermo, Italy.
authors: Egle
authors: E
authors: Corrado
keywords: Atherosclerosis; Clinical implications; Degenerative aortic stenosis; Pathogenesis; The elderly