Even though ramipril did not significantly reduce the TGFβ protein level, which is an important fibrotic factor, it has been shown that angiotensin II activates the synthesis and secretion of TGF-beta1 and that the angiotensin converting enzyme and TGF-beta1 mRNA are associated in the human heart with AS [40]. Here, TGFB1 is linked to aortic stenosis.