Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men

Lida Khurrami; Jacob Eifer Møller; Jes Sanddal Lindholt; Grazina Urbonaviciene; Flemming Hald Steffensen; Jess Lambrechtsen; Marek Karon; Lars Frost; Martin Busk; Kenneth Egstrup; Maise Høigaard Fredgart; Axel Cosmus Pyndt Diederichsen

doi:10.1136/heartjnl-2021-319023

Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men

Lida Khurrami, Jacob Eifer Møller, Jes Sanddal Lindholt, Grazina Urbonaviciene, Flemming Hald Steffensen, Jess Lambrechtsen, Marek Karon, Lars Frost, Martin Busk, Kenneth Egstrup, Maise Høigaard Fredgart, Axel Cosmus Pyndt Diederichsen

Department of Cardiology

16 Citations (Scopus)

Abstract

OBJECTIVE: Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers.

METHODS: Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association.

RESULTS: 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not.

CONCLUSIONS: AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU.

TRIAL REGISTRATION NUMBER: NCT03946410 and ISRCTN12157806.

Original language	English
Article number	319023
Journal	Heart (British Cardiac Society)
Volume	107
Issue number	19
Pages (from-to)	1536-1543
Number of pages	8
ISSN	1355-6037
DOIs	https://doi.org/10.1136/heartjnl-2021-319023
Publication status	Published - Oct 2021

Keywords

Aged
Aortic Valve Stenosis/diagnosis
Aortic Valve/diagnostic imaging
Calcinosis/diagnosis
Cardiovascular Diseases/epidemiology
Cross-Sectional Studies
Denmark/epidemiology
Heart Disease Risk Factors
Humans
Male
Middle Aged
Prevalence
Risk Assessment/methods
Severity of Illness Index
Tomography, X-Ray Computed

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10.1136/heartjnl-2021-319023

Cite this

Khurrami, L., Møller, J. E., Lindholt, J. S., Urbonaviciene, G., Steffensen, F. H., Lambrechtsen, J., Karon, M., Frost, L., Busk, M., Egstrup, K., Fredgart, M. H., & Diederichsen, A. C. P. (2021). Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men. Heart (British Cardiac Society), 107(19), 1536-1543. Article 319023. https://doi.org/10.1136/heartjnl-2021-319023

Khurrami, L, Møller, JE, Lindholt, JS, Urbonaviciene, G, Steffensen, FH, Lambrechtsen, J, Karon, M, Frost, L, Busk, M, Egstrup, K, Fredgart, MH & Diederichsen, ACP 2021, 'Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men', Heart (British Cardiac Society), vol. 107, no. 19, 319023, pp. 1536-1543. https://doi.org/10.1136/heartjnl-2021-319023

@article{250539ce13ae40f8b09ecd2618d857f1,

title = "Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men",

abstract = "OBJECTIVE: Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers.METHODS: Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association.RESULTS: 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0\%), the AVC score was >0 and 215 (1.5\%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95\% CI 1.06 to 1.09)), hypertension (REC 1.24 (95\% CI 1.09 to 1.41)), obesity (REC 1.34 (95\% CI 1.20 to 1.50)), known CVD (REC 1.16 (95\% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95\% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not.CONCLUSIONS: AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU.TRIAL REGISTRATION NUMBER: NCT03946410 and ISRCTN12157806.",

keywords = "Aged, Aortic Valve Stenosis/diagnosis, Aortic Valve/diagnostic imaging, Calcinosis/diagnosis, Cardiovascular Diseases/epidemiology, Cross-Sectional Studies, Denmark/epidemiology, Heart Disease Risk Factors, Humans, Male, Middle Aged, Prevalence, Risk Assessment/methods, Severity of Illness Index, Tomography, X-Ray Computed",

author = "Lida Khurrami and M{\o}ller, \{Jacob Eifer\} and Lindholt, \{Jes Sanddal\} and Grazina Urbonaviciene and Steffensen, \{Flemming Hald\} and Jess Lambrechtsen and Marek Karon and Lars Frost and Martin Busk and Kenneth Egstrup and Fredgart, \{Maise H{\o}igaard\} and Diederichsen, \{Axel Cosmus Pyndt\}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = oct,

doi = "10.1136/heartjnl-2021-319023",

language = "English",

volume = "107",

pages = "1536--1543",

journal = "Heart (British Cardiac Society)",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "19",

}

TY - JOUR

T1 - Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men

AU - Khurrami, Lida

AU - Møller, Jacob Eifer

AU - Lindholt, Jes Sanddal

AU - Urbonaviciene, Grazina

AU - Steffensen, Flemming Hald

AU - Lambrechtsen, Jess

AU - Karon, Marek

AU - Frost, Lars

AU - Busk, Martin

AU - Egstrup, Kenneth

AU - Fredgart, Maise Høigaard

AU - Diederichsen, Axel Cosmus Pyndt

N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/10

Y1 - 2021/10

N2 - OBJECTIVE: Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers.METHODS: Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association.RESULTS: 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not.CONCLUSIONS: AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU.TRIAL REGISTRATION NUMBER: NCT03946410 and ISRCTN12157806.

AB - OBJECTIVE: Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers.METHODS: Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association.RESULTS: 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not.CONCLUSIONS: AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU.TRIAL REGISTRATION NUMBER: NCT03946410 and ISRCTN12157806.

KW - Aged

KW - Aortic Valve Stenosis/diagnosis

KW - Aortic Valve/diagnostic imaging

KW - Calcinosis/diagnosis

KW - Cardiovascular Diseases/epidemiology

KW - Cross-Sectional Studies

KW - Denmark/epidemiology

KW - Heart Disease Risk Factors

KW - Humans

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Risk Assessment/methods

KW - Severity of Illness Index

KW - Tomography, X-Ray Computed

UR - https://www.scopus.com/pages/publications/85112742303

U2 - 10.1136/heartjnl-2021-319023

DO - 10.1136/heartjnl-2021-319023

M3 - Journal article

C2 - 34376488

SN - 1355-6037

VL - 107

SP - 1536

EP - 1543

JO - Heart (British Cardiac Society)

JF - Heart (British Cardiac Society)

IS - 19

M1 - 319023

ER -

Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men

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