Treating aortic stenosis: arresting the snowball effect

Abstract

Aortic stenosis is common and potentially fatal. Recent key insights into the pathophysiology of this disease suggest it is likely to represent a self-perpetuating cycle of injury where tissue calcification is the major driver. Also, the mechanisms governing this appear closely related to calcium homeostasis and bone metabolism. Manipulation of these processes may offer a means by which aortic stenosis progression can be inhibited using drugs currently licensed to treat osteoporosis. Indeed, a prospective randomized controlled trial is currently underway for determining whether denosumab or bisphosphonates can slow aortic stenosis disease. If successful, this would meet a major unmet clinical need.

Keywords:

• 18F-fluoride
• aortic stenosis
• bisphosphonates
• calcification
• denosumab
• osteoporosis

Financial & competing interests disclosure

The authors were supported by the British Heart Foundation. T Pawade and D Newby were principle investigators of the randomized controlled clinical trial SALTIRE 2: Bisphosphonates and RANKL Inhibition in Aortic Stenosis NCT02132026. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.