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68 | Chapter 4 valve is in a post-mortem analysis of a patient’s aortic valve who had the diagnosis of familial hypercholesterolemia (9). If atherosclerosis is an initiating event in this patient population, would lipid-lowering strategies be effective for the slowing of disease progression? In the present study (3), patientswithhe-FHwereexposed toextremelyhigh levelsof LDLbefore statin treatment, especially those with mutational he-FH. Since these patients were first diagnosed with hypercholesterolemia, they have been treated with statins; this approach dramatically lowered LDL-C levels and thereby reduced the predictive value of LDL-C toward AoVC. The authors (3) proposed that the benefits of the statins are for patients who received the statins early in the atherosclerotic process (9), before the development of calcification and eventually severe stenosis. Furthermore, they hypothesized that the results of randomized controlled trials (6) that tested the effect of statins in CAVD may be due to the initiation of treatment in patients with advanced calcific disease. In conclusion, the present study (3) is the first to combine biochemical analysis with genetic LDL receptor function and the calcifying phenotype in the heart. The study further confirms the hypothesis regarding the possible modification and slowing of CAVD progression with the use of long-term lipid lowering if the therapy is initiated in the early stages of pre-clinical CAVD, the atherosclerotic phase (9).