Aortic sclerosis treatment

Overview
Aortic sclerosis is non-obstructive degeneration of the aortic valve that presents predominantly in patients over 65 years of age who have risk factors for coronary artery disease. Because aortic sclerosis is associated with coronary artery disease risk factors, it is also associated with a significant increase in the risk of cardiovascular death, myocardial infarction even in the absence of hemodynamically significant left ventricular outflow tract obstruction. Therefore, despite normal trans-valvular hemodynamic parameters, management of patients with aortic sclerosis is required.

Risk Factor Modification

 * Aortic sclerosis has been suggested as a marker of increased cardiovascular risk, including increased mortality. Therefore, risk factor reduction among this patient population is reasonable although no definitive study has demonstrated reduction in aortic sclerosis progression achieved with aggressive management of hypertension and dyslipidemia


 * Both the SALTRIE and the ASTRONOMER trials failed to demonstrate any reduction in disease progression, with addition of statins in patients with mild to moderate calcific aortic stenosis.


 * Furthermore, the SEAS study also demonstrated no significant reduction in the composite outcome of combined aortic-valve events and ischemic events in patients who received aggressive lipid lowering therapy with simvastatin and ezetimibe.

Antithrombotic Therapy
Patients with isolated aortic valve disease rarely experience embolic events, hence no antithrombotic therapy is required for the prevention of calcific microemboli.

===2008 ACCP Guidelines Recommendation === {{cquote|

Grade 2
1. In patients with isolated calcific aortic valve disease who have not had ischemic stroke or transient ischemic attack, we suggest against antithrombotic therapy. (Level of Evidence: C)

2. In patients with isolated calcific aortic valve disease who have had ischemic stroke or transient ischemic attack not attributable to another source, we suggest aspirin (50 to 100 mg/d). (Level of Evidence: C)}}

Endocarditis Prophylaxis

 * According to the 2008 ACC/AHA guidelines, no antibiotic prophylaxis is recommended for patients with aortic sclerosis.

Guidelines Resources

 * Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)


 * 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons