Increasing evidence suggests that aortic stenosis is an atherosclerosis-like process. As this pathophysiological condition is characterized by increased calcification and a remodelling of the aortic valve, Côté et al. sought to determine whether plasma levels of oxidized LDL (oxLDL) were associated with markers of aortic stenosis. For that purpose, they studied the aortic valves of 105 patients who underwent aortic valve replacement. They showed that the degree of valvular tissue remodelling was associated with increased valve calcification. Male gender (β=0.23±0.09, p=0.01), the presence of hypertension (β=0.18±0.09, p=0.04), and plasma levels of oxLDL (β=0.02±0.006, p<0.001) appeared to be independent predictors of valvular tissue remodelling. In this cohort, the best predictors of oxLDL were found to be tobacco use as well as triglyceride and apolipoprotein B levels. Based on the close relationship between oxLDL levels and valvular tissue remodelling, the authors suggested that further studies are required to investigate whether oxLDL particles are involved in the pathophysiology of aortic stenosis or are simply markers of an atherogenic lipoprotein-lipid profile predictive of aortic stenosis. The paper was accompanied by an editorial by Nalini M. Rajamannan who highlighted the fact that Côté et al. have provided the first quantitative evidence linking oxLDL and the level of aortic valve calcification at the time of valve replacement. The editorial acknowledged that the method used to analyze the degree of tissue remodelling of the aortic valves was quite sophisticated. Given the importance of lipids as predictors of both atherosclerosis and aortic stenosis, Rajamannan also underlined the similarities between valvular and vascular disease.
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