Association of aortic valve calcification and vitamin K antagonist treatment

Abstract

Aims Vitamin K antagonists (VKAs) are suspected of causing aortic valve calcification (AVC). The objective of this study was to clarify whether patients undergoing VKA treatment have increased AVC scores compared to patients treated with new oral anticoagulants (NOACs) and patients who never have been treated with VKA/NOAC. Methods and results We included participants from the population-based DANCAVAS trial (n = 15 048). Information on confounders was collected, and the AVC scores were measured on non-contrast computed tomography scans. The participants’ medication data, including VKA and NOAC data, were collected from the Danish National Health Service Prescription Database. The final population consisted of 14 604 participants (67.4 years, 95% men) of whom 873 had been treated with VKA and 602 with NOAC. The association between AVC score and duration of anticoagulant use was investigated in an adjusted zero-inflated negative binomial regression model. For every year treated with VKA, the AVC score increased, on average, by 6% [ratio of expected counts (RECs) = 1.06; 95% confidence interval (CI) 1.02–1.10] compared to non-use. The results were consistent in sensitivity analyses excluding patients with known cardiovascular disease and statin users (REC = 1.07; 95% CI 1.02–1.11 and REC = 1.10; 95% CI 1.03–1.17, respectively). NOAC treatment was not significantly associated with AVC score in any of the corresponding models (REC = 1.03, 1.02, and 0.96). Conclusion Compared to no treatment with anticoagulants, VKA use was associated with increased AVC score, while a similar association could not be established for NOAC.

Vitamin K2—a neglected player in cardiovascular health: a narrative review

“…104 105 Sønderskov et al recently demonstrated that among 14 604 participants within the Danish Cardiovascular Screening (DANCAVAS) trial, VKA use was associated with progression of aortic valve calcification, evidenced by a 6% increase in calcification with each year of treatment. 106 These results remained consistent after a sensitivity analysis excluding patients with cardiac risk factors on statins showed no progression of calcification in those taking direct oral anticoagulants.…”

Bioprosthetic valves and atrial fibrillation: Direct anticoagulants or warfarin

“…6 There is some concern that chronic use of VKAs can result in native valvular calcification. 7 If a similar phenomenon is seen in the prosthetic valves, it can be detrimental for their durability. Further investigations and more data are warranted in these areas.…”

Sam68 promotes osteogenic differentiation of aortic valvular interstitial cells by TNF-α/STAT3/autophagy axis

“…Valve tissues were obtained within 1 h after being removed from patients during surgical procedures. Clinical information was gathered and the aortic valve calcification (AVC) score of calcific patients was measured as reported (Sonderskov et al 2020). Briefly, calcification was defined as occurring in the leaflet of the valve, the sinus of Valsalva (beginning 6 mm below the coronaries ostium).…”