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.
National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.
George
G
Thanassoulis
Joseph M
JM
Massaro
Ricardo
R
Cury
Emily
E
Manders
Emelia J
EJ
Benjamin
Ramachandran S
RS
Vasan
L Adrienne
LA
Cupple
Udo
U
Hoffmann
Christopher J
CJ
O'Donnell
Sekar
S
Kathiresan
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