The aortic valve sclerosis (AVS) is associated with cardiovascular event independently of the stenosis. In particular, the association with coronary artery disease (CAD) and mitral valve sclerosis (MVS) is frequent. The authors present a review of the literature on the possible pathogenetic mechanism that leads to an acute cardiovascular event in case of concomitant AVS, MVS and CAD. In particular, is discussed the mechanism of atherosclerosis that involves the three structures by the best scientific evidence found in the literature.