Sex-and race-specific burden of aortic valve calcification among older adults without overt coronary heart disease: The Atherosclerosis Risk in Communities Study

• Published in: Atherosclerosis 2022-08, Vol.355, p.68-75
• Main Authors: Boakye, Ellen, Dardari, Zeina, Obisesan, Olufunmilayo H., Osei, Albert D., Wang, Frances M., Honda, Yasuyuki, Dzaye, Omar, Osuji, Ngozi, Carr, John Jeffery, Howard-Claudio, Candace M., Wagenknecht, Lynne, Konety, Suma, Coresh, Josef, Matsushita, Kunihiro, Blaha, Michael J., Whelton, Seamus P.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic valve calcification; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Atherosclerosis - diagnostic imaging; Atherosclerosis - epidemiology; Calcinosis; Cardiovascular risk factors; Coronary Artery Disease - epidemiology; Female; Humans; Lipoprotein(a); Male; Older adults; Prevalence; Race; Risk Factors; Sex
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2022.06.003

The prevalence of aortic valve calcification (AVC) increases with age. However, the sex-and race-specific burden of AVC and associated cardiovascular risk factors among adults ≥75 years are not well studied. We calculated the sex-and race-specific burden of AVC among 2283 older Black and White adults (mean age:80.5 [SD:4.3] years) without overt coronary heart disease from the Atherosclerosis Risk in Communities Study who underwent non-contrast cardiac-gated CT-imaging at visit 7 (2018–2019). Using Poisson regression with robust variance, we calculated the adjusted prevalence ratios (aPR) of the association of AVC with cardiovascular risk factors. The overall AVC prevalence was 44.8%, with White males having the highest prevalence at 58.2%. The prevalence was similar for Black males (40.5%), White females (38.9%), and Black females (36.8%). AVC prevalence increased significantly with age among all race-sex groups. The probability of any AVC at age 80 years was 55.4%, 40.0%, 37.3%, and 36.2% for White males, Black males, White females, and Black females, respectively. Among persons with prevalent AVC, White males had the highest median AVC score (100.9 Agatston Units [AU]), followed by Black males (68.5AU), White females (52.3AU), and Black females (46.5AU). After adjusting for cardiovascular risk factors, Black males (aPR:0.53; 95%CI:0.33–0.83), White females (aPR:0.68; 95%CI:0.61–0.77), and Black females (aPR:0.49; 95%CI:0.31–0.77) had lower AVC prevalence compared to White males. In addition, systolic blood pressure, non-HDL-cholesterol, and lipoprotein (a) were independently associated with AVC, with no significant race/sex interactions. AVC, although highly prevalent, was not universally present in this cohort of older adults. White males had ∼50–60% higher prevalence than other race-sex groups. Moreover, cardiovascular risk factors measured in older age showed significant association with AVC. [Display omitted] •The prevalence of aortic valve calcification in a cohort of older adults was 44.8%.•A significant proportion of older adults did not have any aortic valve calcification.•White males had the highest prevalence, nearly 50–60% higher than other race-sex groups.•Cardiovascular risk factors were associated with aortic valve calcification with no race/sex interactions.