Abstract 3910: Long-term Exposure to Traditional Atherosclerotic Risk Factors and Presence of Aortic Valve Calcification
Background: Traditional atherosclerotic risk factors (RFs) have been associated with aortic valve calcification (AVC) in cross-sectional studies. A single time point measure of a RF may misestimate its cumulative effect. We took advantage of the longitudinal design of the Framingham Heart Study (FHS) to study the associations of long-term RF measures with the presence of AVC.
Methods: In 1339 FHS participants (mean age 60 years, 53% women), we performed non-contrast cardiac multi-detector computed tomography between 2002–2005. In the ~30 years prior to AVC measurement, each participant attended a maximum of 7 clinic examinations where RFs were measured. Using stepwise logistic regression, we studied the association of longitudinal RFs with the presence of AVC (AVC Agatston score>0 vs AVC=0). Covariates included age, sex, total cholesterol, HDL cholesterol, hypertension status, body mass index, smoking, diabetes, and lipid lowering therapy. For dichotomous covariates, we used a proportion of exams with positive exposure status; for quantitative covariates, we used a mean value from all examinations attended. A P<0.05 was used as the significance threshold in the stepwise logistic model.
Results: AVC was present in 37% of participants (46% of men and 29% of women). In multivariable models, the odds ratios for the presence of AVC (versus absence) associated with every 10 year increase in age was 3.72 (95% CI, 3.06, 4.52) and female sex was 0.46 (95% CI, 0.34, 0.64). In addition to age and sex, the long-term average of several major atherosclerosis RFs was significantly associated with AVC in stepwise models (Table⇓). In particular, the OR for AVC associated with every 10mg/dL increase in long-term mean total cholesterol was 1.17 (95% CI, 1.12 to 1.23).
Conclusions: Long-term exposure to multiple atherosclerotic RFs, including altered lipoprotein levels, is associated with AVC. To prevent AVC in the elderly, RF levels may need to be lowered starting in middle adulthood.