Valvular heart disease
Incidence and Progression of Aortic Valve Calcium in the Multi-Ethnic Study of Atherosclerosis (MESA)

https://doi.org/10.1016/j.amjcard.2009.10.071Get rights and content

Aortic valve calcium (AVC) is common among older adults and shares epidemiologic and histopathologic similarities to atherosclerosis. However, prospective studies have failed to identify meaningful risk associations with incident (“new”) AVC or its progression. In the present study, AVC was quantified from serial computed tomographic images from 5,880 participants (aged 45 to 84 years) in the Multi-Ethnic Study of Atherosclerosis, using the Agatston method. Multivariate backward selection modeling was used to identify the risk factors for incident AVC and AVC progression. During a mean follow-up of 2.4 ± 0.9 years, 210 subjects (4.1%) developed incident AVC. The incidence rate (mean 1.7%/year) increased significantly with age (p <0.001). The risk factors for incident AVC included age, male gender, body mass index, current smoking, and the use of lipid-lowering and antihypertensive medications. Among those with AVC at baseline, the median rate of AVC progression was 2 Agatston units/year (interquartile range −21 to 37). The baseline Agatston score was a strong, independent predictor of progression, especially among those with high calcium scores at baseline. In conclusion, in this ethnically diverse, preclinical cohort, the rate of incident AVC increased significantly with age. The incident AVC risk was associated with several traditional cardiovascular risk factors, specifically age, male gender, body mass index, current smoking, and the use of both antihypertensive and lipid-lowering medications. AVC progression risk was associated with male gender and the baseline Agatston score. Additional research is needed to determine whether age- and stage-specific mechanisms underlie the risk of AVC progression.

Section snippets

Methods

MESA was initiated by the National Heart, Lung, and Blood Institute (Bethesda, Maryland) to characterize subclinical cardiovascular disease (CVD) and its progression. A full description of the study design and recruitment process has been previously reported.1 A total of 6,814 free-living people without clinically apparent CVD, aged 45 to 84 years, were recruited from 6 United States communities (Baltimore City and County, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles

Results

Of the 5,880 subjects with follow-up CT examinations, the mean between-scan interval was 2.4 ± 0.9 years. A total of 5,142 subjects (87%) did not have AVC on the baseline CT examination, and 738 (13%) had prevalent AVC, with a median Agatston score of 56 (IQR 19 to 137). As shown in Figure 1, the former group included the population at risk of incident AVC, and the latter group defined the population at risk of AVC progression. The baseline demographic characteristics of this population are

Discussion

The present analysis of the MESA cohort, using quantitative measures of AVC from serial CT imaging, has provided important insights into early-stage AVC in a primary prevention population. Although it is well-known that AVC prevalence increases with age,7 ours is the first to show that the incidence rate of AVC increases with age and that age is independently associated with disease initiation. Thus, AVC is more common with age because of both the accumulation of cases and an increase in the

Acknowledgment

We thank Susan Larsen, BA, for assistance in manuscript preparation and the other investigators, staff, and participants of the MESA study for their valuable contributions. A full list of the participating MESA investigators and institutions can be found at www.mesa-nhlbi.org.

References (25)

  • R.C. Bahler et al.

    Factors leading to progression of valvular aortic stenosis

    Am J Cardiol

    (1999)
  • D.E. Bild et al.

    Multi-ethnic study of atherosclerosis: objectives and design

    Am J Epidemiol

    (2002)
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    This research was supported by grant R01-HL-63963-01A1, and by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

    Dr. Budoff has received honoraria from, and is on, the Speakers' Bureau of GE Healthcare (Bethesda, Maryland). Dr. O'Brien has received honoraria from, and is on, the Speakers' Bureaus of AstraZeneca (Wilmington, Delaware), Bristol-Myers Squibb (New York, New York), and Merck and Co., Inc. (Whitehouse Station, New Jersey).

    Drs. Owens, Katz and O'Brien had full access to the data and take responsibility for its integrity. All authors have read and approve the manuscript as submitted.

    The National Heart, Lung, and Blood Institute participated in the design and conduct of the MESA study, and the National Heart, Lung, and Blood Institute Project Office reviewed and approved the manuscript before submission.

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