You are here

Article Text

Article menu
Download PDFPDF
Valvular heart disease
Original research
Traditional and novel risk factors for incident aortic stenosis in community-dwelling older adults
  1. Daniele Massera1,
  2. Traci M Bartz2,
  3. Mary L Biggs2,
  4. Nona Sotoodehnia3,4,
  5. Alexander P Reiner5,
  6. Richard D Semba6,
  7. John S Gottdiener7,
  8. Bruce M Psaty4,
  9. David S Owens3,
  10. Jorge R Kizer8,9
  1. 1 Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
  2. 2 Department of Biostatistics, University of Washington, Seattle, Washington, USA
  3. 3 Division of Cardiology, University of Washington, Seattle, Washington, USA
  4. 4 Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington, USA
  5. 5 Department of Epidemiology, University of Washington, Seattle, Washington, USA
  6. 6 Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  7. 7 Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  8. 8 Cardiology Section, San Francisco VA Health Care System, San Francisco, California, USA
  9. 9 Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jorge R Kizer, Cardiology Section, San Francisco VA Health Care System, San Francisco, CA 94121, USA; jorge.kizer{at}ucsf.edu

Abstract

Objectives Calcific aortic stenosis (AS) is the most common valvular disease in older adults, yet its risk factors remain insufficiently studied in this population. Such studies are necessary to enhance understanding of mechanisms, disease management and therapeutics.

Methods The Cardiovascular Health Study is a population-based investigation of older adults that completed adjudication of incident AS over long-term follow-up. We evaluated traditional cardiovascular risk factors or disease, as well as novel risk factors from lipid, inflammatory and mineral metabolism pathways, in relation to incident moderate or severe AS (including AS procedures) and clinically significant AS (severe AS, including procedures).

Results Of 5390 participants (age 72.9±5.6 years, 57.6% female, 12.5% black), 287 developed moderate or severe AS, and 175 clinically significant AS, during median follow-up of 13.1 years. After full adjustment, age (HR=1.66 per SD (95% CI=1.45, 1.91)), male sex (HR=1.41 (1.06, 1.87)), diabetes (HR=1.53 (1.10, 2.13)), coronary heart disease (CHD, HR=1.36 (1.01, 1.84)), lipoprotein-associated phospholipase-A2 (LpPLA2) activity (HR=1.21 per SD (1.07, 1.37)) and sCD14 (HR=1.16 per SD (1.01, 1.34)) were associated with incident moderate/severe AS, while black race demonstrated an inverse association (HR=0.40 (0.24, 0.65)), and creatinine-based estimated glomerular filtration rate (eGFRcr) showed a U-shaped relationship. Findings were similar for clinically significant AS, although CHD and sCD14 fell short of significance, but interleukin-(IL) 6 showed a positive association.

Conclusion This comprehensive evaluation of risk factors for long-term incidence of AS identified associations for diabetes and prevalent CHD, LpPLA2 activity, sCD14 and IL-6, and eGFRcr. These factors may hold clues to biology, preventive efforts and potential therapeutics for those at highest risk.

  • aortic valve stenosis
  • epidemiology
  • risk factors

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2023-322709

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request.

    View Full Text

    Footnotes

    • Twitter @danmassera

    • Contributors Planning for this research was conducted by DM, TMB, MLB, JSG, BMP, DSO and JRK. The project was conducted by DM, TMB, DSO and JRK. All authors were involved in reporting the work. JRK serves as guarantor.

    • Funding This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, 75N92021D00006, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. DM was supported by the Glorney-Raisbeck Fellowship Program, Corlette Glorney Foundation, and the New York Academy of Medicine. DSO was supported by a Mentored Clinical and Population Research Award from the American Heart Association’s Western States Affiliate. JRK was supported by K24HL135413 from the NHLBI.

    • Competing interests DM has received consulting fees from Bristol Meyers Squibb, Sanofi Genzyme and Tenaya Therapeutics. JRK reports stock ownership in Abbott, AbbVie, Bristol Myers Squibb, Johnson & Johnson, Medtronic, Merck and Pfizer. BMP serves on the steering committee of the Yale Open Data Access Project, funded by Johnson & Johnson.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • 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.