Abstract 17756: Incidence and Progression of Aortic Valve Calcification among the Elderly: a Prospective Analysis of the Age, Gene-Environment Susceptibility (AGES)-Reykjavik Study
Background: There are currently no effective treatments for calcific aortic valve disease, and determinants of aortic valve calcium (AVC) initiation and progression in the elderly are poorly understood.
Methods: Among 5764 participants in the AGES-Reykjavik study, 3285 returned for follow up. Demographics, risk factors and cardiac CT scans were assessed at both time points, and AVC was retrospectively scored using phantom-adjusted Agatston methodology. Multivariable logistic and linear regression was used to determine risk associations for incident AVC and AVC progression, respectively.
Results: Of 3,149 subjects (58% female, age 75±5 years) with interpretable CT scans at both exams, 1,215 (39%) had baseline AVC. Over median follow-up of 5.3 (range 2.6-9.2) years, n=389 (20.1%, 4.1% / year) developed incident AVC. Risk factors for incident AVC varied by anatomic location (central vs. annular extension). Age (p<0.0005), antihypertensive therapy (p=0.006) and height (p=0.03) were associated with central AVC, while age (p=0.002), BMI (p=0.02) and active smoking (p=0.005) were associated with inward extension from the annulus into the valve leaflets. The median rate of AVC progression was 10 [IQR: 3, 31] Agatston units/year. Age (p=0.001), baseline AVC score (p<0.0005), and diastolic BP (p<0.05) were associated with AVC progression. The relationship between baseline AVC and AVC progression appeared linear. Smoking was positively associated with AVC progression among the lowest tertile of AVC scores, but negatively associated among the highest tertile, suggesting the influence of survival bias.
Conclusions: To our knowledge, this is the largest cohort examining AVC incidence and progression, with the longest duration of follow up. AVC incidence and progression both increase significantly with age. Risk factors for incident AVC appear anatomic location-specific, while baseline AVC is a strong, linear predictor of AVC progression.
- © 2012 by American Heart Association, Inc.