Vitamin K Deficiency and Vascular Calcification. Is There Any Evidence about Its Impact on Coronary Artery Disease?

Nowadays cardiovascular disease remain globally the leading cause of mortality. Coronary artery disease is the predominant clinical entity related to fatal cardiovascular events, while its development is mostly associated with progressive atherosclerosis of the vessels combined with gradual vascular calcification. It is well described and understood that vascular calcification is strongly associated with the occurrence of CVD and increased mortality rates. Therefore, it is essential to understand the metabolic pathways leading to its formation in order to develop effective therapies. A group of vitamin-k dependent proteins seems to play a significant role on the prevention of the arterial wall. Several past studies have shown that in cases of vitamin-k deficiency the process of vessel calcification is accelerated. Vitamin-k depletion and high levels of uncarboxylated and dephosphorylated forms of the aforementioned proteins are considered as important factors that contribute significantly to this rapid progression. Promising studies are giving the stimulus for further research in the field of vitamin-k supplementation and the suspension of vascular calcification

Perspective Chapter: Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction; Early Replacement or Conservative Treatment?

Aortic stenosis (AS) is the most common valve lesion among the continuously aging population with serious effect on the left ventricular ejection fraction (LVEF). If left untreated, it is associated with serious complications such as heart failure (HF), pulmonary hypertension, thromboembolic events, and even sudden death. Early diagnosis and treatment is of outmost importance to avoid the above complications but also to maintain the patient’s normal heart function. Echocardiography is the key examination that assesses the severity of the stenosis, valve calcification, left ventricular (LV) function, and wall thickness. Also new imaging methods such as cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) help in assessing the severity of aortic valve stenosis when echocardiography has limitations. Based on the categorization of the severity of the stenosis, its treatment is determined. Although things are clear in cases of asymptomatic disease and severe stenosis, this is not the case in moderate disease. Experts and clinical trials do not define clearly which cases can be treated conservatively and which need surgical or transcatheter intervention. The purpose of this article is to gather all the latest data on the treatment of moderate aortic stenosis, especially in patients with heart failure and low ejection fraction