Aortic stenosis, heart valve disease may be caused by inflammation, family history doubles risk

By: Dr. Victor Marchione | Heart Health | Tuesday, February 23, 2016 - 01:00 PM

aortic-stenosis-heart-valve-disease-may-be-caused-by-inflammationThe most common form of heart valve disease, aortic stenosis, may be linked to inflammation and, according to an extensive study, family history doubles the risk of the disease.

Research outlined in the journal Circulation demonstrates that certain pathways of inflammation are underlying factors in the development of aortic stenosis – the heart valve disease caused by calcium deposits and narrowing of the aortic valve.

The researchers looked at heart valves in patients who were undergoing surgery for different valve problems. They discovered a group of inflammation substances known as “leukotrienes” in calcified heart valves. The most inflammation was detected in people with the narrowest valves. The study also showed that “leukotrienes” could stimulate the calcification of heart valve cells in cell cultures.

Aortic stenosis is normally seen in the elderly population. However, it can also be a birth defect.

Researchers involved in the study, which was conducted at the Karolinska Institutet in Sweden, are saying that the results of their work suggest anti-inflammatory medications may be an option to treat heart valve disease in the future. Some say it would be great if inflammation medications could slow the progression of aortic stenosis so that surgery, especially for the elderly, could be avoided.

Risk of aortic stenosis doubles with family history

An extensive study involving information from over 4.2 million Danish residents born in or after 1920 showed that aortic stenosis doubles with family history.

The analysis of heart valve cases, which were recorded when they occurred around the age of 35 years or older, ended in 2012 and the results were announced in 2013. Patients with any record of a congenital heart defect or those with cardiovascular disease at the age of 35 were excluded from the study. Family history was defined as a first-degree relative with a recorded diagnosis of aortic stenosis.

During the study, close to 30,000 people were registered as having aortic stenosis at 35 years old. Of those, 193 had a first-degree relative with the heart valve disease. Doctors noted that the risk of aortic stenosis roughly doubled when patients had a first-degree relative with the disease. Also, the disease seemed to happen earlier in life for patients with a family history of aortic stenosis.

Interestingly, the Danish study also showed that the risk of the heart valve disease increased by 8-fold in patients with ischemic heart disease and a family history of aortic stenosis, compared to those with no family history of ischemic heart disease. People with ischemic heart disease experience reduced blood supply to the heart.

Aortic stenosis treatment and prevention

aortic-stenosis-heart-valve-disease-may-be-caused-by-inflammationPeople who suffer from aortic stenosis complain about chest pain or pressure in their chest, as well as feeling as if their heart is pounding or racing. They can also feel very tired, dizzy, and short of breath. Sometimes medications can lessen the severity of these symptoms. However, the only way to fully treat aortic stenosis is through surgery. An operation can repair or replace the valve.

On the upside, aortic stenosis treatment does not always mean that surgery is needed right away. Tests could indicate that a person has mild or moderate heart valve disease. In severe cases, a doctor must monitor the heart valve carefully, but it does not mean that an operation happens immediately. Surgery is likely to take place, but at a time that is deemed safe for the patient.

Essentially, aortic treatment guidelines are dependent on how the disease progresses. Severely diseased aortic valves can be replaced with one of two options: surgical aortic valve replacement (AVR), which is a common open-heart surgery, or transcatheter aortic valve replacement (TAVR) – a less invasive procedure than open-heart that allows a new valve to be inserted within the diseased aortic valve.

Of course, no one wants to get to the point where they require any type of surgery, be it invasive or not. There are a few potential ways to prevent aortic stenosis, such as making sure you treat strep throat, which can lead to rheumatic fever. Research indicates that addressing risk factors for coronary artery disease may also lower your risk of heart valve problems. These factors include obesity, high blood pressure, and high cholesterol. Since studies show that there could be a connection between infected gums and infected heart tissue, taking care of teeth and gums is also a good idea.

It is important to consider lifestyle when it comes to the heart. Regular exercise is good for your heart. If you happen to have mild aortic stenosis, you can still enjoy physical activities. If you have severe heart valve disease, you should avoid strenuous exercise. To be safe, check with your doctor before starting any new exercise routine.

Avoiding smoking, eating low-salt and low-fat foods, and maintaining a healthy weight is also recommended.

People with mild aortic stenosis should still be monitored even if they don’t experience a lot of symptoms. If you fall into this category, your doctor might order an echocardiogram to view your heart valve every few years. In cases of moderate valve disease, the echocardiogram should be conducted more often. With severe aortic stenosis, patients are accustomed to seeing their doctor every three to six months.

According to the Journal of The American College of Cardiology, about 67,000 surgical aortic valve replacements are performed each year in the United States.

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