Aortic stenosis: is it simply a degenerative process or an active atherosclerotic process?

Aortic stenosis remains the most common cause of cardiac valve replacement in developed countries. The prevalence of this condition increases with age, and many of the risk factors for coronary artery disease also appear related to the development and progression of aortic stenosis. Recent studies also suggest a relationship between calcium and lipid accumulation in both coronary artery disease and aortic stenosis. Most important, there is growing evidence that aggressive treatment of coronary artery disease risk factors, particularly hyperlipidemia, may influence the progression of aortic stenosis. In this article the current literature is reviewed as it relates to vascular biology, pathogenesis of aortic valve disease, and current and newly emerging management approaches in the care of the patient with aortic stenosis.