Abstract

Aortic valve stenosis (aortic stenosis) is an uncommon vascular disease, affecting 2-4% of adults >60 years of age. No medical treatments are known to prevent or slow progression of the disease, and valve replacement is the only option in severe, symptomatic cases, which otherwise have a 1-year mortality of up to 50%. The pathophysiology of aortic stenosis shares some similarities with coronary atherosclerosis, but because it is relatively uncommon, studies of risk factors for aortic stenosis have been hampered by small numbers. This is changing, however, with the increased availability of routinely-collected healthcare data for record linkage to large prospective studies. I will discuss the example of the Million Women Study, which by linkage to UK hospital admissions data includes over 4000 cases of aortic stenosis and 1600 aortic valve replacements, as well as over 70,000 cases of coronary heart disease. These data improve on sample sizes of previous studies by an order of magnitude. I will present results of analyses of risk of aortic stenosis in relation to known vascular disease risk factors. Given the failure of lipid-lowering therapies to slow progression of the disease in recent clinical trials, these findings provide new hope that there are modifiable risk factors for severe aortic stenosis.