Advertisement

Bone Modifiers and the Quest to Slow Progression of Aortic Stenosis

      Aortic stenosis (AS) will likely become increasingly frequent with the aging of the American population. The difficulties in treating elderly patients with critical AS emphasize the potential value of a strategy to slow the advancement of aortic valve calcification. Recent prospective trials of statins and angiotensin-converting enzyme inhibitors have been disappointing. New options are needed to achieve a truly effective strategy for retarding the advancement of AS. In this context, the observations of Skolnick et al appearing in this issue of The American Journal of Cardiology are particularly intriguing. In a retrospective review of patients followed for mild or moderate AS, these investigators found that 18 patients receiving treatment for osteoporosis had significantly less decrement in aortic valve area on follow-up echocardiography than 37 not receiving such treatment. The most attractive explanation is an action of drug therapy for osteoporosis, most often bisphosphonates, to retard aortic valve calcification. The mechanism for this action is not clear, although numerous possibilities can be postulated on the basis of the multiple complex processes controlling tissue calcification. In conclusion, the investigators' findings deserve further study to clarify drug impact on aortic valve calcification as well as confirm the clinical findings in a larger and more diverse population. Such investigation should also assess the role of vitamin D and calcium supplementation, common features of treatment for osteoporosis. Currently available results are too preliminary to justify the use of bisphosphonates or other osteoporosis therapies to slow the progression of AS.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Roberts C.M.
        At 93, confronted with the decision of a lifetime; facing the end on his terms.
        The Washington Post. 2004; (August 29): A.01
        • Rosengart T.K.
        • Feldman T.
        • Borger M.A.
        • Vassiliades Jr, T.A.
        • Gillinov A.M.
        • Hoercher K.J.
        • Vahanian A.
        • Bonow R.O.
        • O'Neill W.
        Percutaneous and minimally invasive valve procedures: a scientific statement from the American Heart Association.
        Circulation. 2008; 117: 1750-1767
        • Messika-Zeitoun D.
        • Bielak L.F.
        • Peyser P.A.
        • Sheedy P.F.
        • Turner S.T.
        • Nkomo V.T.
        • Breen J.F.
        • Maalouf J.
        • Scott C.
        • Tajik A.J.
        Aortic valve calcification.
        Arterioscler Thromb Vasc Biol. 2007; 27: 642-648
        • Otto C.M.
        Calcific aortic stenosis—time to look more closely at the valve.
        N Engl J Med. 2008; 359: 1395-1398
        • O'Brien K.D.
        Pathogenesis of calcific aortic valve disease.
        Arterioscler Thromb Vasc Biol. 2006; 26: 1721-1728
        • Rossebø A.B.
        • Pedersen T.R.
        • Boman K.
        • Brudi P.
        • Chambers J.B.
        • Egstrup K.
        • Gerdts E.
        • Gohlke-Bärwolf C.
        • Holme I.
        • Kesäniemi Y.A.
        • Malbecq W.
        • Nienaber C.A.
        • Ray S.
        • Skjaerpe T.
        • Wachtell K.
        • Willenheimer R.
        • SEAS Investigators
        Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis.
        N Engl J Med. 2008; 359: 1343-1356
        • Rosenhek R.
        • Rader F.
        • Loho N.
        • Gabriel H.
        • Heger M.
        • Klaar U.
        • Schemper M.
        • Binder T.
        • Maurer G.
        • Baumgartner H.
        Statins but not angiotensin-converting enzyme inhibitors delay progression of aortic stenosis.
        Circulation. 2004; 110: 1291-1295
        • Skolnick A.H.
        • Osranek M.
        • Formica P.
        • Kronzon I.
        Osteoporosis treatment and progression of aortic stenosis.
        Am J Cardiol. 2009; 103: 122-124
        • Tamura K.
        • Suzuki Y.
        • Matsushita M.
        • Fujii H.
        • Miyaura C.
        • Aizawa S.
        • Kogo H.
        Prevention of aortic calcification by etidronate in the renal failure rat model.
        Eur J Pharmacol. 2007; 558: 159-166
        • Drake M.T.
        • Clarke B.L.
        • Khosla S.
        Bisphosphonates: mechanism of action and role in clinical practice.
        Mayo Clin Proc. 2008; 83: 1032-1045
        • Mohler III, E.R.
        • Chawla M.K.
        • Chang A.W.
        • Vyahare N.
        • Levy R.J.
        • Graham L.
        • Gannon F.H.
        Identification and characterization of calcifying valve cells from human and canine aortic valves.
        J Heart Valve Dis. 1999; 8: 254-260
        • Price P.A.
        • Faus S.A.
        • Williamson M.K.
        Bisphosphonates alendronate and ibandronate inhibit artery calcification at doses comparable to those that inhibit bone resorption.
        Arterioscler Thromb Vasc Biol. 2001; 21: 817-824
        • Demer L.L.
        • Tintut Y.
        Vascular calcification.
        Circulation. 2008; 117: 2938-2948