Максим Осипов писал(а):Уважаемый Сергей, атеросклероз не поражает клапаный аппарат сердца.
Кстати говоря, неплохая тема для обсуждения. Дисскуссия в литературе достаточно широкая.
Is Aortic Valve Stenosis a Manifestation of Atherosclerosis?
Raphael Rosenhek, MD
Presenter: Emile R. Mohler, III, MD, Director of Vascular Medicine, University of Pennsylvania Health System, Philadelphia
Leading researchers, including Dr. Mohler, continue to debate about whether aortic valve sclerosis is, in fact, just another manifestation of atherosclerosis. This debate stems from the fact that there are a number of similarities between vascular and valvular degeneration -- they are both associated with:
Inflammation
Lipid infiltration
Dystrophic calcification
Ossification
Platelet deposition
Endothelial dysfunction
As discussed by Dr. Mohler, in contrast to the aforementioned factors, the architecture of each valvular or vascular lesion is strikingly different. A number of recent publications have tried to illuminate some of these aspects.
Calcification/Ossification
The presence of osteopontin in calcified human aortic valves suggests that it is a regulatory protein in pathologic calcification.[1] Bone formation has also been demonstrated in heavily calcified carotid lesions devoid of ulceration and hemorrhage.[2]
Role of Inflammation in Calcific Valvular Heart Disease
Another structural difference between valvular and vascular lesions concerns a possible role of inflammation in calcific valvular heart disease.[3]
Angiotensin-converting enzyme is present in aortic sclerosis and in stenotic lesions, where it may participate in lesion development.[4] It is also possible that accumulation of tenascin, followed by matrix metalloproteinase-2, may instead be associated with progression of calcification.[5]
Role of Statin Therapy for Preventing Aortic Stenosis?
A group of studies have suggested a possible beneficial effect of statin therapy for the prevention of aortic stenosis progression. The demonstrated impact of low-density lipoprotein cholesterol levels on the progression of aortic valve calcification suggested that lipid-lowering therapy might decrease the progression of aortic valve calcification.[6] In another study, a proliferative atherosclerosis-like process occurred in the aortic valve during experimental hypercholesterolemia in a rabbit model, and this was inhibited by atorvastatin.[7] Finally, a study reported that statins may decrease aortic valve calcium accumulation in humans.[8]
Taken together, these new insights into the pathology of aortic valve sclerosis allow for possibility of new approaches for delaying the progression of degenerative aortic valve disease.