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Aortic valve sclerosis and pathogenesis of calcific aortic stenosis

Marc Dweck, MD, PhD
Catherine M Otto, MD
Section Editor
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Aortic valve thickening (sclerosis) without stenosis is common in elderly adults [1]. It is often detected either as a systolic murmur on physical examination or on echocardiography or computed tomography performed for some other reason. Aortic valve sclerosis is important clinically because it can progress to aortic stenosis and is a marker for increased cardiovascular risk.

This topic will discuss the pathogenesis of aortic sclerosis and calcific aortic stenosis and the diagnosis, prevalence, clinical significance, and management of aortic sclerosis. The natural history, diagnosis, and management of aortic stenosis are discussed separately. (See "Natural history, epidemiology, and prognosis of aortic stenosis" and "Clinical manifestations and diagnosis of aortic stenosis in adults" and "Medical management of symptomatic aortic stenosis" and "Medical management of asymptomatic aortic stenosis in adults" and "Indications for valve replacement in aortic stenosis in adults".)


The prevalence of aortic valve sclerosis in adults increases with age, with rates <10 percent in most study populations with mean age less than 60 years [2]. As an example, in the Monica-KORA study of 935 European adults aged 35 to 84 years, the prevalence of aortic sclerosis increased across the age distribution from 7 percent in those age 35 to 44 years to 65 percent in those age 75 to 84 years [3]. Sclerosis of the aortic valve is found in around one quarter of individuals ≥65 years of age [1,4-6], although the rate may be higher in selected individuals of the same age such as those presenting to the emergency department with chest pain [7]. The prevalence is even higher in with more advanced age: for example, 35 percent between 75 and 84 years of age, and around 50 percent of those over age 80 [5,8].

Valvular sclerosis is more common in patients with hypertension and electrocardiographic evidence of left ventricular hypertrophy [9] and in those with end-stage renal disease on maintenance dialysis. Among dialysis patients, aortic and mitral valve sclerosis have been noted in 55 to 69 percent and 40 to 60 percent, respectively [10,11]. When adjusted for other cardiovascular risk factors, moderate chronic kidney disease is not significantly associated with aortic valve calcification, but is associated with mitral annular calcification among patients with diabetes [12]. (See "Valvular heart disease in patients with end-stage renal disease", section on 'Valvular thickening' and "Valvular heart disease in patients with end-stage renal disease", section on 'Valvular and annular calcification'.)


The pathobiology of aortic sclerosis and early calcific aortic valve disease shares similarities with atherosclerosis involving lipid accumulation, inflammation, and calcification. Calcification predominates in more advanced stages of aortic stenosis driving valve stiffness and narrowing. The pathobiology of calcific aortic valve disease is an area of active research, and our understanding of the cellular and molecular mechanisms of disease is in flux [13-15].

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Literature review current through: Nov 2017. | This topic last updated: Jan 05, 2017.
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