Apolipoprotein E alleles and bicuspid aortic valve stenosis in monozygotic twins

Aortic valve disease is a common valvular heart disease but the underlying pathology that leads to the severe dysfunction of the aortic valve is unclear. There is increasing interest in the role of hypercholesterolaemia in the causation and progression of aortic valve disease. Apolipoprotein E is an essential component of cholesterol and previous studies have reported conflicting results on the association between various apolipoprotein E alleles and aortic valve disease. We report two interesting cases of severe dysfunction of bicuspid aortic valves in twin brothers who presented to us at the same time.