Original Research
Prevalence of Aortic Valve Calcium and the Long-Term Risk of Incident Severe Aortic Stenosis

https://doi.org/10.1016/j.jcmg.2023.02.018Get rights and content

Abstract

Background

Aortic valve calcification (AVC) is a principal mechanism underlying aortic stenosis (AS).

Objectives

This study sought to determine the prevalence of AVC and its association with the long-term risk for severe AS.

Methods

Noncontrast cardiac computed tomography was performed among 6,814 participants free of known cardiovascular disease at MESA (Multi-Ethnic Study of Atherosclerosis) visit 1. AVC was quantified using the Agatston method, and normative age-, sex-, and race/ethnicity-specific AVC percentiles were derived. The adjudication of severe AS was performed via chart review of all hospital visits and supplemented with visit 6 echocardiographic data. The association between AVC and long-term incident severe AS was evaluated using multivariable Cox HRs.

Results

AVC was present in 913 participants (13.4%). The probability of AVC >0 and AVC scores increased with age and were generally highest among men and White participants. In general, the probability of AVC >0 among women was equivalent to men of the same race/ethnicity who were approximately 10 years younger. Incident adjudicated severe AS occurred in 84 participants over a median follow-up of 16.7 years. Higher AVC scores were exponentially associated with the absolute risk and relative risk of severe AS with adjusted HRs of 12.9 (95% CI: 5.6-29.7), 76.4 (95% CI: 34.3-170.2), and 380.9 (95% CI: 169.7-855.0) for AVC groups 1 to 99, 100 to 299, and ≥300 compared with AVC = 0.

Conclusions

The probability of AVC >0 varied significantly by age, sex, and race/ethnicity. The risk of severe AS was exponentially higher with higher AVC scores, whereas AVC = 0 was associated with an extremely low long-term risk of severe AS. The measurement of AVC provides clinically relevant information to assess an individual’s long-term risk for severe AS.

Section snippets

Study participants

A total of 6,812 participants from MESA had noncontrast cardiac CT performed at visit 1 (2000-2002) with AVC scoring. Participants 45 to 84 years of age who were free of clinically apparent CVD were recruited from 6 communities within the United States who self-identified their race/ethnicity as White, Black, Hispanic, or Chinese.8 The MESA protocol was approved by the Institutional Review Boards at the participating institutions, and written informed consent was given by all participants.

Quantification of AVC

Results

The mean age of participants was 62.1 ± 10.2 years of age, and 53% were women. Overall, there were 913 participants (13.4%) with AVC >0. Participants with AVC >0 were approximately 10 years older on average than participants with AVC = 0 and had a higher burden of traditional CVD risk factors (Table 1). Among participants with AVC >0, 211 (23%) had AVC between 100 and 299 AU, and 114 (13%) had AVC ≥300 AU (Figure 1).

The probability of AVC >0 was higher with older age for both men and women in a

Discussion

To the best of our knowledge, this is the first report to: 1) provide age, sex, and race/ethnicity reference AVC percentiles from a community-based sample of people free of CVD from the United States; and 2) examine the association of CT-measured AVC with the long-term risk for adjudicated severe AS. Our results provide the foundation for a reference tool highlighting the importance of age, sex, and race/ethnicity in the clinical interpretation of AVC scoring. They also provide a robust

Conclusions

These results provide the first age-, sex-, and race/ethnicity-specific reference values for AVC, which will help inform cutoffs for defining an elevated AVC score and provide an important framework for the clinical interpretation of AVC scores. These results also demonstrate that AVC is very strongly associated with the long-term risk for adjudicated severe AS and that the risk increases exponentially with higher AVC scores. Of similar importance, AVC = 0 is associated with an exceptionally

Funding Support and Author Disclosures

This research was supported by R01 HL071739, and MESA was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National

Acknowledgments

The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

References (27)

  • A.C. Razavi et al.

    Risk markers for limited coronary artery calcium in persons with significant aortic valve calcium (from the Multi-Ethnic Study of Atherosclerosis)

    Am J Cardiol

    (2021)
  • A.M. Greve et al.

    Effect modifications of lipid-lowering therapy on progression of aortic stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] study)

    Am J Cardiol

    (2018)
  • C.W. Tsao et al.

    Heart disease and stroke statistics-2022 update: a report from the American Heart Association

    Circulation

    (2022)
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