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CLINICAL STUDIES

Prevalence and correlates of aortic regurgitation in american indians: the Strong Heart Study

Nathaniel E. Lebowitz, MD^a, Jonathan N. Bella, MD^a, Mary J. Roman, MD, FACC^a, Jennifer E. Liu, MD^a, Dawn P. Fishman, BA^a, Mary Paranicas, BA^a, Elisa T. Lee, PhD^*, Richard R. Fabsitz, MA, MPH, Thomas K. Welty, MD, Barbara V. Howard, PhD and Richard B. Devereux, MD, FACC^a

^a Department of Medicine, The New York Hospital–Cornell Medical Center, New York, New York, USA
^* School of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
National Heart Lung and Blood Institute, Bethesda, Maryland, USA
Aberdeen Area Tribal Chairman’s Health Board, Rapid City, South Dakota, USA
Medlantic Research Institute, Washington, DC, USA

Manuscript received December 9, 1998; revised manuscript received January 28, 2000, accepted March 30, 2000.

Reprint requests and correspondence: Dr. Richard B. Devereux, Division of Cardiology, Box 222, The New York Presbyterian Hospital–Weill Cornell Medical Center, 525 East 68th Street, New York, New York 10021
rbdevere{at}med.cornell.edu

OBJECTIVES

We sought to determine the prevalence and correlates of aortic regurgitation (AR) in a population-based sample group.

BACKGROUND

Concern over induction of AR by weight loss medication highlights the importance of assessing the prevalence and correlates of AR in unselected patient groups.

METHODS

Aortic regurgitation was assessed by color flow Doppler echocardiography in 3,501 American Indian participants age 47 to 81 years during the second Strong Heart Study.

RESULTS

Mild (1+) AR was present in 7.3%, 2+ AR in 2.4% and 3+ to 4+ AR in 0.3% of participants, more frequently in those 60 years old than in those <60 years old (14.4% vs. 5.8%, p < 0.001); AR was unrelated to gender. Compared with participants without AR, those with mild AR had a lower body mass index (p < 0.004) and higher systolic pressure (p < 0.003). Participants with AR had larger aortic root diameters (3.6 ± 0.4 vs. 3.4 ± 0.4 cm, p < 0.001), higher creatinine levels (1.3 ± 1.3 vs. 1.0 ± 1.0 mg/dl, p < 0.001) and higher urine albumin/creatinine levels (3.6 ± 2.3 vs. 3.3 ± 2.0 log, p < 0.001), as well as higher prevalences of aortic stenosis (AS) or mitral stenosis (MS) (p < 0.001). Regression analysis showed that AR was independently related to older age and larger aortic roots (p < 0.0001), AS and absence of diabetes (p = 0.002), MS (p = 0.003) and higher log urine albumin/creatinine (p = 0.005).

CONCLUSIONS

Aortic regurgitation occurred in 10% of a sample group of middle-aged to older adults and was related to older age, larger aortic root diameter, aortic and mitral stenosis and albuminuria. There was no association of AR with being overweight and a negative association of AR with diabetes.

Abbreviations and Acronyms   AR = aortic regurgitation   AS = aortic stenosis   ASE = American Society of Echocardiography   ECG = electrocardiographic   JNC-V = Fifth report of the Joint National Committee on detection, evaluation and treatment of high blood pressure   LV = left ventricle   MS = mitral stenosis   SHS = Strong Heart Study

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