Bidirectional nexus between metabolic disease and aortic valve calcification: from pathogenic mechanisms to integrated multimorbidity management

ABSTRACT Introduction Calcified aortic valve disease (CAVD) imposes a severe global health burden, and there is currently no effective pharmacotherapy, which urgently requires a new understanding of pathophysiology to guide treatment. Areas covered This review systematically evaluates the epidemiological association and common mechanistic pathways between metabolic diseases and aortic valve calcification (AVC) through the proposed ‘calcification-metabolic axis’ framework. We conducted a comprehensive literature search, covering the PubMed database up to December 2025, with a focus on studies related to CAVD, metabolism, inflammation, and calcification signaling. Expert opinion Future management strategies must transition toward early, multi-disease co-governance strategies. At the same time, targeted drugs will be developed for specific pathways on this axis, surpassing the current treatment status of relying solely on valve replacement surgery.