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

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.