Abstract 5751: Aortic Valve Calcification is Prospectively Associated with Primary Cardiovascular Events Independent of Subclinical Coronary Artery Disease Severity: the Multi-Ethnic Study of Atherosclerosis (MESA)
Calcific aortic valve disease is associated with increased cardiovascular (CV) morbidity and mortality in the elderly. It is unknown whether this association is independent of inflammation and subclinical coronary artery disease (CAD), or generalizable to a younger, healthier and more ethnically diverse cohort. Baseline risk factors and CT-determined aortic valve calcium (AVC) and coronary artery calcium (CAC) scores were assessed in 6,772 MESA participants (mean age 62 years; 53% female) free of CV disease at baseline. Multivariate Cox proportional hazards regression was performed using a pre-specified combined endpoint of fatal/non-fatal stroke, myocardial infarction, adjudicated CV death or resuscitated arrest (‘CVD event’). At baseline, 843 (12.5%) had prevalent AVC. Those with AVC had a higher prevalence of CAC (85% vs. 45%, p<0.001) and higher median CAC scores (205 vs. 69, p<0.001). Median follow up was 4.1 years, with 170 CVD events. Event rates were higher for the AVC vs. no AVC group (1.8% vs. 0.5% per year, Panel A). After adjustment for demographics, risk factors, inflammation, and CAC severity (Panel B, Model 4), AVC remained significantly associated with CVD events (HR 1.52; 95%CI 1.05, 2.20). In this relatively young, healthy and multi-ethnic cohort, AVC predicts primary CVD events independent of CV risk factors, inflammation and subclinical CAD severity. Those with AVC are at increased risk of primary CVD events and may warrant more intensive preventive therapies. The mechanisms for this independent association merit further investigation.