CLINICAL STUDY: VALVE DISEASE
Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease?
Insights from a population-based study
Yoram Agmon, MD*,1,
Bijoy K. Khandheria, MD, FACC*,
Irene Meissner, MD ,
JoRean D. Sicks, MS ,
W. Michael O’Fallon, PhD,
David O. Wiebers, MD,
Jack P. Whisnant, MD,
James B. Seward, MD, FACC* and
A. Jamil Tajik, MD, FACC*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Department of Health Science Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Manuscript received September 26, 2000;
revised manuscript received May 1, 2001,
accepted May 17, 2001.
Reprint requests and correspondence: Dr. Bijoy K. Khandheria, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
khandheria{at}mayo.edu
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.
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Abbreviations and Acronyms
| | 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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