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Review paper
Published online: 2021-10-13
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Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications

Joanna Natorska12
DOI: 10.33963/KP.a2021.0137
·
Pubmed: 34643267
Affiliations
  1. Department of Experimental Cardiac Surgery, Anesthesiology, and Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  2. Krakow Center for Medical Research and Technologies, John Paul II Hospital, Kraków, Poland

open access

Online first
Review article
Published online: 2021-10-13

Abstract

Aortic stenosis (AS) is a progressive disease, with no pharmacological treatment. The prevalence of diabetes mellitus (DM) among AS patients is higher than in the general population. DM significantly increases the risk of AS development and the rate of its progression from mild to severe. However, a mechanism of the interaction between AS and DM is not fully understood. Limited data regarding the influence of hyperglycemia on valvular calcification are available, while understanding the cross-talk between them is pivotal to design an effective therapeutic approach to prevent or at least retard AS development and/or progression in DM patients. Analysis of aortic stenotic valves revealed that increased accumulation of advanced glycoxidation end products (AGEs) was associated with enhanced valvular oxidative stress, inflammation, expression of coagulation factors and markers of calcification. Moreover, AGEs valvular expression correlated with AS severity. Interestingly, in diabetic AS patients valvular inflammation correlated only with long-term glycemic control parameters, i.e. glycated hemoglobin and fructosamine but not with serum glucose levels. It has been demonstrated that transcatheter aortic valve replacement (TAVI) is beneficial for AS patients also with concomitant DM and safer as compared to surgical aortic valve replacement (SAVR). Moreover, new antidiabetic drugs, such as glucagon-like peptide-1 receptor antagonists agents and sodium-glucose cotransporter-2, inhibitors targeting an inhibition of AGEs-mediated oxidative, have been proposed to reduce the risk of AS development in DM patients. The aim of this review was to comprehensively discuss the impact of DM on AS and its potential therapeutic implications.

Abstract

Aortic stenosis (AS) is a progressive disease, with no pharmacological treatment. The prevalence of diabetes mellitus (DM) among AS patients is higher than in the general population. DM significantly increases the risk of AS development and the rate of its progression from mild to severe. However, a mechanism of the interaction between AS and DM is not fully understood. Limited data regarding the influence of hyperglycemia on valvular calcification are available, while understanding the cross-talk between them is pivotal to design an effective therapeutic approach to prevent or at least retard AS development and/or progression in DM patients. Analysis of aortic stenotic valves revealed that increased accumulation of advanced glycoxidation end products (AGEs) was associated with enhanced valvular oxidative stress, inflammation, expression of coagulation factors and markers of calcification. Moreover, AGEs valvular expression correlated with AS severity. Interestingly, in diabetic AS patients valvular inflammation correlated only with long-term glycemic control parameters, i.e. glycated hemoglobin and fructosamine but not with serum glucose levels. It has been demonstrated that transcatheter aortic valve replacement (TAVI) is beneficial for AS patients also with concomitant DM and safer as compared to surgical aortic valve replacement (SAVR). Moreover, new antidiabetic drugs, such as glucagon-like peptide-1 receptor antagonists agents and sodium-glucose cotransporter-2, inhibitors targeting an inhibition of AGEs-mediated oxidative, have been proposed to reduce the risk of AS development in DM patients. The aim of this review was to comprehensively discuss the impact of DM on AS and its potential therapeutic implications.

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Keywords

aortic stenosis, diabetes, hyperglycemia, inflammation, risk factors

About this article
Title

Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Review paper

Published online

2021-10-13

DOI

10.33963/KP.a2021.0137

Pubmed

34643267

Keywords

aortic stenosis
diabetes
hyperglycemia
inflammation
risk factors

Authors

Joanna Natorska

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