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Original research
Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men
  1. Lida Khurrami1,
  2. Jacob Eifer Møller1,2,
  3. Jes Sanddal Lindholt3,4,5,
  4. Grazina Urbonaviciene6,
  5. Flemming Hald Steffensen7,
  6. Jess Lambrechtsen1,
  7. Marek Karon8,
  8. Lars Frost6,
  9. Martin Busk7,
  10. Kenneth Egstrup1,
  11. Maise Høigaard Fredgart1,
  12. Axel Cosmus Pyndt Diederichsen1,4,5
  1. 1 Department of Cardiology, Odense University Hospital, Odense, Denmark
  2. 2 Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  3. 3 Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
  4. 4 Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark
  5. 5 University of Southern Denmark, Odense, Denmark
  6. 6 Department of Cardiology, Regional Hospital of Central Jutland, Silkeborg, Denmark
  7. 7 Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
  8. 8 Department of Medicine, Nykøbing Falster Hospital, Region Zealand, Denmark
  1. Correspondence to Dr Lida Khurrami, Cardiology, Odense Universitetshospital, Odense, Denmark; drlkdk{at}


Objective Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60–74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers.

Methods Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association.

Results 14 073 men aged 60–74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0–82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not.

Conclusions AVC was prevalent in the general population of men aged 60–74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU.

Trial registration number NCT03946410 and ISRCTN12157806.

  • coronary angiography
  • coronary artery disease
  • risk factors
  • diagnostic imaging
  • heart valve diseases

Data availability statement

Data are available on reasonable request. Study data were collected and managed using REDCap data management, hosted at the Odense Patient data Explorative Network.

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Data availability statement

Data are available on reasonable request. Study data were collected and managed using REDCap data management, hosted at the Odense Patient data Explorative Network.

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  • Correction notice This article has been corrected since it was first published online. Author name 'Martin Buske' has been corrected to 'Martin Busk'.

  • Contributors Writing: LK, JEM, ACPD. Statistical analysis, table and figures: LK. CT scans: description, quality control and inter-intra observer variability test: MHF, GU, MK, MB, FHS, JL. Project: idea, planning and coordination: ACPD, JSL, KE, JL, LF, FHS. All authors have contributed to the content of the final version of the manuscript.

  • Funding The first author has received funding from the University of Southern Denmark and from the Region of Southern Denmark.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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