Aortic Valve Calcification: Determinants and Progression in the Population

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 27; no. 3; pp. 642 - 648
• Main Authors: Messika-Zeitoun, David, Bielak, Lawrence F., Peyser, Patricia A., Sheedy, Patrick F., Turner, Stephen T., Nkomo, Vuyisile T., Breen, Jerome F., Maalouf, Joseph, Scott, Christopher, Tajik, A Jamil, Enriquez-Sarano, Maurice
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.03.2007; Hagerstown, MD Lippincott
• Subjects: Age Distribution; Aged; Aortic Valve; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Calcinosis - diagnosis; Calcinosis - epidemiology; Cardiology. Vascular system; Cardiovascular system; Causality; Cohort Studies; Comorbidity; Disease Progression; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Valve Diseases - diagnosis; Heart Valve Diseases - epidemiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Multivariate Analysis; Prevalence; Probability; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Risk Assessment; Severity of Illness Index; Sex Distribution; Tomography, X-Ray Computed; Vascular disease; computed tomography; Aortic valve calcification; Cardiac valvular disease; Atherosclerosis; Cardiovascular disease; Computerized axial tomography; calcification; Epidemiology; Aortic valve
• ISSN: 1079-5642; 1524-4636; 1524-4636
• DOI: 10.1161/01.ATV.0000255952.47980.c2

BACKGROUND—Aortic valve calcification (AVC) is considered degenerative. Recent data suggested links to atherosclerosis or coronary disease (CAD). METHODS AND RESULTS—AVC and coronary artery calcifications (CAC) were prospectively assessed by Electron-Beam-Computed-Tomography in 262 population-based research participants ≥60 years. AVC was frequent (27%) with aging (P<0.01) and in men (P<0.05). AVC was associated with diabetes, hypertension, higher body-mass-index, and serum glucose (all P<0.05). AVC was a marker of higher prevalence (P<0.01) and severity of CAD (CAC score441±802 versus 265±566, P<0.05) independently of age. After follow-up of 3.8±0.9 years, AVC score increased (94±271 versus 54±173, P<0.01, +11±32 U/year), faster with higher baseline AVC score (P<0.01). Compared with participants remaining free of AVC, de novo acquisition of AVC was associated with higher LDL-cholesterol (141±31 versus 121±27 mg/dL, P<0.05) and faster CAC progression (+78±87 versus +28±47 U/year, P<0.05). In multivariate analysis, LDL-cholesterol independently determined AVC acquisition while higher baseline AVC scores determined faster progression of existing AVC. CONCLUSION—In the population, AVC is frequent with aging and atherosclerotic risk factors. AVC is a marker of subclinical CAD. AVC is progressive, appearing de novo with progressive atherosclerosis whereas established AVC progresses independently of atherosclerotic risk factors and faster with increasing initial AVC loads.