Clinical study: valve disease
Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease?: Insights from a population-based study

Presented, in part, at the 73rd Scientific Sessions of the American Heart Association, November 2000, New Orleans, Louisana (abstract published in Circulation1999;102 Suppl:II760).
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Abstract

OBJECTIVES

The aim of this study was to examine the association between atherosclerosis risk factors, aortic atherosclerosis and aortic valve abnormalities in the general population.

BACKGROUND

Clinical and experimental studies suggest that aortic valve sclerosis (AVS) is a manifestation of the atherosclerotic process.

METHODS

Three hundred eighty-one subjects, a sample of the Olmsted County (Minnesota) population, were examined by transthoracic and transesophageal echocardiography. The presence of AVS (thickened valve leaflets), elevated transaortic flow velocities and aortic regurgitation (AR) was determined. The associations between atherosclerosis risk factors, aortic atherosclerosis (imaged by transesophageal echocardiography) and aortic valve abnormalities were examined.

RESULTS

Age, male gender, body mass index (odds ratio [OR]: 1.07 per kg/m2; 95% confidence interval [CI]: 1.02 to 1.12), antihypertensive treatment (OR: 1.93; CI: 1.12 to 3.32) and plasma homocysteine levels (OR: 1.89 per twofold increase; CI: 0.99 to 3.61) were independently associated with an increased risk of AVS. Age, body mass index and pulse pressure (OR: 1.21 per 10 mm Hg; CI: 1.00 to 1.46) were associated with elevated (upper quintile) transaortic velocities, whereas only age was independently associated with AR. Sinotubular junction sclerosis (p = 0.001) and atherosclerosis of the ascending aorta (p = 0.03) were independently associated with AVS and elevated transaortic velocities, respectively.

CONCLUSIONS

Atherosclerosis risk factors and proximal aortic atherosclerosis are independently associated with aortic valve abnormalities in the general population. These observations suggest that AVS is an atherosclerosis-like process involving the aortic valve.

Abbreviations

AR
aortic regurgitation
AVS
aortic valve sclerosis
CAD
coronary artery disease
CI
95% confidence interval(s)
HDL
high-density lipoprotein
LDL
low-density lipoprotein
OR
odds ratio(s)
SPARC
Stroke Prevention: Assessment of Risk in a Community study
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography

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Supported, in part, by research grant NS06663 from the NINDS.

1

Dr. Agmon is now at the Rambam Medical Center in Haifa, Israel.