@article {1476, title = {Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study.}, journal = {J Am Coll Cardiol}, volume = {29}, year = {1997}, month = {1997 Mar 01}, pages = {630-4}, abstract = {

OBJECTIVES: The aim of this study was to determine the prevalence of aortic sclerosis and stenosis in the elderly and to identify clinical factors associated with degenerative aortic valve disease.

BACKGROUND: Several lines of evidence suggest that degenerative aortic valve disease is not an inevitable consequence of aging and may be associated with specific clinical factors.

METHODS: In 5,201 subjects > or = 65 years of age enrolled in the Cardiovascular Health Study, the relation between aortic sclerosis or stenosis identified on echocardiography and clinical risk factors for atherosclerosis was evaluated by using stepwise logistic regression analysis.

RESULTS: Aortic valve sclerosis was present in 26\% and aortic valve stenosis in 2\% of the entire study cohort; in subjects > or = 75 years of age, sclerosis was present in 37\% and stenosis in 2.6\%. Independent clinical factors associated with degenerative aortic valve disease included age (twofold increased risk for each 10-year increase in age), male gender (twofold excess risk), present smoking (35\% increase in risk) and a history of hypertension (20\% increase in risk). Other significant factors included height and high lipoprotein(a) and low density lipoprotein cholesterol levels.

CONCLUSIONS: Clinical factors associated with aortic sclerosis and stenosis can be identified and are similar to risk factors for atherosclerosis.

}, keywords = {Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Calcinosis, Female, Heart Valve Diseases, Humans, Male, Prospective Studies, Risk Factors, Sclerosis}, issn = {0735-1097}, author = {Stewart, B F and Siscovick, D and Lind, B K and Gardin, J M and Gottdiener, J S and Smith, V E and Kitzman, D W and Otto, C M} } @article {596, title = {Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly.}, journal = {N Engl J Med}, volume = {341}, year = {1999}, month = {1999 Jul 15}, pages = {142-7}, abstract = {

BACKGROUND: Although aortic-valve stenosis is clearly associated with adverse cardiovascular outcomes, it is unclear whether valve sclerosis increases the risk of cardiovascular events.

METHODS: We assessed echocardiograms obtained at base line from 5621 men and women 65 years of age or older who were enrolled in a population-based prospective study. On echocardiography, the aortic valve was normal in 70 percent (3919 subjects), sclerotic without outflow obstruction in 29 percent (1610), and stenotic in 2 percent (92). The subjects were followed for a mean of 5.0 years to assess the risk of death from any cause and of death from cardiovascular causes. Cardiovascular morbidity was defined as new episodes of myocardial infarction, angina pectoris, congestive heart failure, or stroke.

RESULTS: There was a stepwise increase in deaths from any cause (P for trend, <0.001) and deaths from cardiovascular causes (P for trend, <0.001) with increasing aortic-valve abnormality; the respective rates were 14.9 and 6.1 percent in the group with normal aortic valves, 21.9 and 10.1 percent in the group with aortic sclerosis, and 41.3 and 19.6 percent in the group with aortic stenosis. The relative risk of death from cardiovascular causes among subjects without coronary heart disease at base line was 1.66 (95 percent confidence interval, 1.23 to 2.23) for those with sclerotic valves as compared with those with normal valves, after adjustment for age and sex. The relative risk remained elevated after further adjustment for clinical factors associated with sclerosis (relative risk, 1.52; 95 percent confidence interval, 1.12 to 2.05). The relative risk of myocardial infarction was 1.40 (95 percent confidence interval, 1.07 to 1.83) among subjects with aortic sclerosis, as compared with those with normal aortic valves.

CONCLUSIONS: Aortic sclerosis is common in the elderly and is associated with an increase of approximately 50 percent in the risk of death from cardiovascular causes and the risk of myocardial infarction, even in the absence of hemodynamically significant obstruction of left ventricular outflow.

}, keywords = {Aged, Angina Pectoris, Aortic Valve, Calcinosis, Cardiovascular Diseases, Cerebrovascular Disorders, Female, Heart Failure, Heart Valve Diseases, Humans, Male, Mortality, Myocardial Infarction, Prospective Studies, Risk, Risk Factors, Ultrasonography, United States, Ventricular Outflow Obstruction}, issn = {0028-4793}, doi = {10.1056/NEJM199907153410302}, author = {Otto, C M and Lind, B K and Kitzman, D W and Gersh, B J and Siscovick, D S} }