Abstract 18575: Quantitative Assessment of Aortic Valve Calcification by Cardiac CT in the Penn Diabetes Heart Study: Association With Cardiovascular Risk Factors and Coronary Artery Calcium
Background: Aortic valve sclerosis is a common degenerative process defined by irregular calcification and thickening of the aortic valve leaflets without impairment in leaflet excursion. Aortic valve sclerosis (AVS) can progress to aortic valve stenosis. It has also shown to be associated with an increased frequency of myocardial infarction and mortality. Although thought to be increased among those with type 2DM, AVS has not been well characterized in this population. The aim of this study was to quantitatively measure AVS visualized on cardiac CT in a diabetic population and determine the risk factors associated with AVS.
Methods: The Penn Diabetes Heart Study is a cross sectional study of T2DM subjects without coronary or renal disease. In all participants free of clinical aortic valve disease and with baseline electron beam cardiac CT, (N=1747, 63.5% male, 61% Caucasian) we quantified aortic valve calcium using the Agatston scoring method. Both logistic and tobit regression, with stepwise backward elimination, were used to examine association of AVS with CHD risk factors.
Results: AVS was seen in 16.0% of participants. In multivariable logistic regression, AVS was independently associated with older age [OR 3.2, 95% CI (2.6-3.9), p<0.001], male gender [OR 2.1 (1.5-3.0), p <0.001], Caucasian race, and hypertension, [OR 2.45, (1.41-4.26), p<0.001]. Associations were similar across increasing AVS Agatston scores in multivariable tobit regression. AVS was not associated with dyslipidemia, smoking, severity of diabetes, or CRP, but was associated with Lp(a) levels [OR 1.3 (1.12-1.50), p<0.001]. The odds of AVS also increased across increasing levels of coronary artery calcium (CAC) [OR for CAC of 2.2 (1.3-3.8), p = 0.002 for AVS Agatston scores of >0 to 100 and OR of 2.4 (1.1-5.3), p = 0.03 for AVS scores >100) in fully adjusted logistic regression models.
Conclusions: In diabetics, male gender, Caucasian race, older age, subclinical atherosclerosis and hypertension were independently associated with presence and extent of AVS, but many traditional CHD risk factors were not. This suggests that type 2 DM itself likely may contribute to the development of AVS. Whether AVS is part of the same process as CAC or forms via distinct mechanisms remains to be determined.
- © 2013 by American Heart Association, Inc.