Natural history of mild and of moderate aortic stenosis-new insights from a large prospective European study.

Increased life expectancy has led to a higher prevalence of calcific aortic valve disease. Both ends of the disease spectrum-sclerosis of the aortic valve without hemodynamic obstruction and the late stage of aortic valve stenosis (AS)-have been associated with increased morbidity and mortality. This raises the question of the prognostic contribution of atherosclerotic diseases and other comorbidities as opposed to the hemodynamic effect of obstructive AS. Hence, the evaluation of asymptomatic patients with mild or moderate AS without comorbidities is of major interest. In the Simvastatin and Ezetimibe in Aortic Stenosis study, with the exception of hypertension, comorbidities were excluded, thus allowing an analysis of the effect of pure AS as well as the effect of hypertension on the progression and outcome of AS. We discuss the results that emerged from this large European prospective study and relate these to the published literature.