New determinants in the evolution of aortic valve stenosis: an updated analysis

Abstract

Background. Aortic valve stenosis is a common condition at elderly population. In addition to the classic risk factors, age and hypertension, recent research has identified others, such as genetic variations affecting lipid metabolism, chronic inflammation, intestinal microbiota imbalance and exposure to pollutants. Objective(s). Evaluation and synthesis of the latest evidence on contemporary predictors involved in accelerated progression of aortic stenosis including genetic, metabolic and environmental aspects. Materials and methods. A comprehensive review of scientific literature published between 2022 and 2024 was conducted, using the PubMed, ScienceDirect, and IEEE Xplore databases, focusing on terms and keywords such as “aortic stenosis,” “nontraditional risk factors.” After applying the inclusion criteria, a total of 115 original articles were analyzed. Results. Recent data highlight the essential role of modern predictors such as genetic predisposition, especially polymorphisms of the LPA gene, has been correlated with a faster disease progression; inflammatory markers—such as osteoprotegerin, TGF-β, and ultrasensitive CRP—reflect chronic systemic inflammation, which is closely associated with calcific valvular degeneration. In addition, metabolic disorders, including type 2 diabetes mellitus and insulin resistance, have been shown to have an accelerating effect on valvular pathology, while intestinal dysbiosis and environmental toxins are recognized as additional aggravating factors. Conclusion(s). The identification of these modern risk factors expands our understanding of aortic stenosis beyond classical models, providing novel insights. Continued research is essential to clarify the interplay between genetic, inflammatory, metabolic, and environmental influences.