title: Predictors of cerebrovascular events and death among patients with valvular heart disease: A population-based study.
abstract: OBJECTIVE
  There is little population-based information on cerebrovascular events and survival among valvular heart disease patients. We used the Kaplan-Meier product-limit method and the Cox proportional hazards model to determine rates and predictors of cerebrovascular events and death among valve disease patients.
  
  
  METHODS
  This population-based historical cohort study in Olmsted County, Minnesota, reviewed residents with a first echocardiographic diagnosis of mitral stenosis (n=19), mitral regurgitation (n=528), aortic stenosis (n=140), and aortic regurgitation (n=106) between 1985 and 1992.
  
  
  RESULTS
  During 2694 person-years of follow-up, 98 patients developed cerebrovascular events and 356 died. Compared with expected numbers, these observations are significantly elevated, with standardized morbidity ratio of 3.2 (95% CI, 2.6 to 3.8) and 2. 5 (95% CI, 2.2 to 2.7), respectively. Independent predictors of cerebrovascular events were age, atrial fibrillation, and severe aortic stenosis. The risk ratio of severe aortic stenosis was 3.5 (95% CI, 1.4 to 8.6), with atrial fibrillation conferring greater risk at younger age. Predictors of death were age, sex, cerebrovascular events, ischemic heart disease, and congestive heart failure, the greatest risk being among those with both congestive heart failure and cerebrovascular events (risk ratio=8.8; 95% CI, 5. 8 to 13.4). Valve disease type and severity were not independent determinants of death.
  
  
  CONCLUSIONS
  The risk of cerebrovascular events and death among patients with valve disease remains high. Age, atrial fibrillation, and severe aortic stenosis are independent predictors of cerebrovascular events, and age, sex, cerebrovascular events, congestive heart failure, and ischemic heart disease are independent predictors of death in these patients.
authors.affiliation: Division of Cerebrovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Petty
authors.forename: B K
authors.initials: BK
authors.lastname: Khandheria
authors.forename: J P
authors.initials: JP
authors.lastname: Whisnant
authors.forename: J D
authors.initials: JD
authors.lastname: Sicks
authors.forename: W M
authors.initials: WM
authors.lastname: O'Fallon
authors.forename: D O
authors.initials: DO
authors.lastname: Wiebers
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis