title: Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA).
abstract: Aortic valve calcium (AVC) is common among older adults and shares epidemiologic and histopathologic similarities to atherosclerosis. However, prospective studies have failed to identify meaningful risk associations with incident ("new") AVC or its progression. In the present study, AVC was quantified from serial computed tomographic images from 5,880 participants (aged 45 to 84 years) in the Multi-Ethnic Study of Atherosclerosis, using the Agatston method. Multivariate backward selection modeling was used to identify the risk factors for incident AVC and AVC progression. During a mean follow-up of 2.4 +/- 0.9 years, 210 subjects (4.1%) developed incident AVC. The incidence rate (mean 1.7%/year) increased significantly with age (p <0.001). The risk factors for incident AVC included age, male gender, body mass index, current smoking, and the use of lipid-lowering and antihypertensive medications. Among those with AVC at baseline, the median rate of AVC progression was 2 Agatston units/year (interquartile range -21 to 37). The baseline Agatston score was a strong, independent predictor of progression, especially among those with high calcium scores at baseline. In conclusion, in this ethnically diverse, preclinical cohort, the rate of incident AVC increased significantly with age. The incident AVC risk was associated with several traditional cardiovascular risk factors, specifically age, male gender, body mass index, current smoking, and the use of both antihypertensive and lipid-lowering medications. AVC progression risk was associated with male gender and the baseline Agatston score. Additional research is needed to determine whether age- and stage-specific mechanisms underlie the risk of AVC progression.
authors.affiliation: University of Washington, Seattle, Washington, USA. dsowens@u.washington.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Owens
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Junichiro
authors.initials: J
authors.lastname: Takasu
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Kevin D
authors.initials: KD
authors.lastname: O'Brien
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data*