Biomarkers of calcification and atherosclerosis in patients with degenerative aortic stenosis in relation to concomitant coronary artery disease

INTRODUCTION There is an ongoing debate regarding aortic valve degenerative processes. Some markers of calcification and atherosclerosis may be potentially useful in establishing their etiology.
OBJECTIVES The aim of the study was to assess the biochemical markers of calcification and atherosclerosis in patients with degenerative aortic stenosis (AS) in relation to the aortic valve calcium score (AVCS) and concomitant coronary artery disease (CAD).
PATIENTS AND METHODS The study involved 88 patients: 68 patients with degenerative AS (group A), including 44 patients with severe AS (A1; 25 patients with CAD) and 24 patients with moderate AS (A2; 13 patients with CAD) and 20 matched subjects as controls (18 patients with CAD). In all patients, clinical data were assessed, laboratory tests were done (including the analysis of serum interleukin4 [IL‑4], osteoprotegerin [OPG], and fetuin‑A levels), coronary angiography was performed, and the AVCS was measured.
RESULTS Study groups and subgroups had comparable serum IL‑4, OPG, and fetuin‑A levels. There were significant differences in the AVCS between patients with severe AS, moderate AS, and controls (3605 ±2542 Agatston units [AU], 1390 ±1143 AU, 100 ±194 AU, respectively; P <0.001). There were no significant correlations between the AVCS and serum IL‑4, OPG, or fetuin‑A levels. In moderate AS, serum OPG levels were higher in subjects with concomitant CAD (5.84 ±1.4 vs. 4.03 ±1.3 pmol/l, P = 0.036). In severe AS, the mean AVCS was similar in patients with and without CAD. Higher AVCS was observed only in patients with moderate AS and coexisting CAD compared with patients without CAD (1644 ±1285 vs. 902 ±789 AU, P = 0.038).
CONCLUSIONS There were no significant differences between patients with and without degenerative AS in selected biochemical markers. The presence of CAD in moderate AS was associated with increased AVCS and serum OPG levels suggesting the effect of atherosclerosis on early valve calcification. In patients with severe AS, there were no correlations between calcification and atherosclerotic markers.