Bicuspid aortic valve, atherosclerosis and changes of lipid metabolism: Are there pathological molecular links?

Bicuspid aortic valve (BAV) is recognized as a syndrome including aortic valve diseases and aortic wall alterations, such as aortic dilatation, dissection and rupture, but also coronary atherosclerosis. The current evidence, although partially controversial, suggests that several molecular mechanisms promoting atherosclerosis are activated in BAV patients and are involved in the progression of the related diseases, from aortic stenosis to aortopathies, along with altered hemodynamics. Among these factors, dyslipidemia (i.e., high LDL cholesterol, high lipoprotein (a)) and the activation of specific pro-inflammatory pathways (nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 inflammasome and Toll-like receptor 4) appear to play a pivotal role in the progression of BAV-associated diseases. The further elucidation of such molecular mechanisms may lead to a better and personalized prognosis and follow-up for BAV patients and suggest novel pharmacological approaches to prevent disease progression.