Associations of long-term and early adult atherosclerosis risk factors with aortic and mitral valve calcium.
OBJECTIVE
To determine the association of long-term exposure to atherosclerosis risk factors with valvular calcification.


BACKGROUND
Traditional atherosclerosis risk factors have been associated with aortic and mitral valve calcium in cross-sectional studies, but long-term prospective data are lacking.


METHODS
This was a prospective, community-based cohort study with 27-year follow-up (median follow-up 26.9 years; range 23.1 to 29.6 years). Participants from the Framingham Offspring Study (n = 1,323, enrolled between 1971 and 1975, mean age at enrollment 34 +/- 9 years; 52% women) underwent cardiac multidetector computed tomography assessment between 2002 and 2005. Associations between the long-term average of each cardiovascular risk factor and valve calcium were estimated using logistic regression.


RESULTS
Aortic valve calcium was present in 39% of participants and mitral valve calcium in 20%. In multivariable models, the odds ratio for aortic valve calcium associated with every SD increment in long-term mean total cholesterol was 1.74 (p < 0.0001); with every SD increment in high-density lipoprotein cholesterol, it was 0.77 (p = 0.002); and with every 9 cigarettes smoked per day, it was 1.23 (p = 0.002). Associations of similar magnitude were seen for mitral valve calcium. The mean of 3 serum C-reactive protein measurements was associated with mitral valve calcium (odds ratio: 1.29 per SD increment in C-reactive protein levels; p = 0.002). A higher Framingham risk score in early adulthood (40 years age or younger) was associated with increased prevalence and severity of aortic valve calcium measured 3 decades later.


CONCLUSIONS
Exposure to multiple atherosclerotic risk factors starting in early to mid-adulthood is associated with aortic and mitral valve calcium. Studies evaluating early risk factor modification to reduce the burden of valve disease are warranted.
Thanassoulis
George
G
National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.
Massaro
Joseph M
JM
Cury
Ricardo
R
Manders
Emily
E
Benjamin
Emelia J
EJ
Vasan
Ramachandran S
RS
Cupple
L Adrienne
LA
Hoffmann
Udo
U
O'Donnell
Christopher J
CJ
Kathiresan
Sekar
S
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001021:Aortic Valve / Q000473:pathology*; D050197:Atherosclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology*; D002118:Calcium / Q000378:metabolism; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors
D002118:Calcium