Medical therapies to prevent the development and progression of calcific aortic valve stenosis: a contemporary review

Introduction: Aortic stenosis (AS), the leading cause of valvular heart disease related mortality, affects 12% of individuals over 75 years and is set to expand as the population ages. Once symptoms develop, severe symptomatic AS carries an average survival of approximately two years. The only management currently available is aortic valve replacement (AVR), either surgically or via transcatheter aortic valve implantation, but this addresses only the end stage of the disease process which is often associated with irreversible myocardial remodeling. There are currently no pharmacotherapies proven to treat AS. The development of this condition is an active pathophysiological process which involves complex metabolic signaling cascades providing myriad potential therapeutic targets. Areas covered: This review looks at recent and ongoing clinical trials of novel pharmacotherapies for AS, including lipid lowering therapy, nitrous oxide pathway targeting, vitamin K supplementation, renin-angiotensin-aldosterone system blockade, repurposing diabetic pharmacotherapies, colchicine, and transthyretin stabilizers. Expert opinion: AS is an active, pathological disease which should be amenable to pharmacological modulation. A wide spectrum of pharmacotherapeutic agents are currently being investigated and the authors of this review are optimistic that we might be on the cusp of a breakthrough.