Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults

Owens, David S.; Bartz, Traci M.; Bůžková, Petra; Massera, Daniele; Biggs, Mary L.; Carlson, Selma; Psaty, Bruce M.; Sotoodehnia, Nona; Gottdiener, John S.; Kizer, Jorge R.

doi:10.1136/heartjnl-2021-319025

Cited by 26 publications

(11 citation statements)

References 32 publications

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“…Only 316 patients in the UK Biobank cohort received aortic or mitral valve interventions. Even if we assume that only 10% of reported AS in this sample was severe, this would imply less than half received an aortic valve intervention, which is similar to a recent finding using the US-based Cardiovascular Health Study 25. A French population-based cohort found similar low uptake of valvular interventions despite high associated societal burden in mortality, readmissions and healthcare costs 26.…”

Section: Discussionsupporting

confidence: 74%

“…Even if we assume that only 10% of reported AS in this sample was severe, this would imply less than half received an aortic valve intervention, which is similar to a recent finding using the US-based Cardiovascular Health Study. 25 A French population-based cohort found similar low uptake of valvular interventions despite high associated societal burden in mortality, readmissions and healthcare costs. 26 Others have highlighted the under-referral of patients with severe MR for surgical repair 27 or transcatheter edge-to-edge repair, 28 and of patients with severe AS for TAVR or SAVR.…”

Section: Discussionmentioning

confidence: 99%

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Valvular disease burden in the modern era of percutaneous and surgical interventions: the UK Biobank

et al. 2022

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BackgroundThe burden of valvular heart disease (VHD) has increased significantly among ageing populations, yet remains poorly understood in the present-day context of percutaneous and surgical interventions.ObjectiveTo define the incidence, clinical correlates and associated mortality of VHD in the UK Biobank cohort.MethodsWe interrogated data collected in the UK Biobank between 1 January 2000 and 30 June 2020. VHD incidence was determined using International Classification of Disease-10 codes for aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis, mitral regurgitation (MR) and mitral valve prolapse. We calculated HRs for incident VHD and all-cause mortality. Clinical correlates of VHD included demographics, coronary artery disease, heart failure and atrial fibrillation. Surgical and percutaneous interventions for mitral and aortic VHD were considered time-dependent variables.ResultsAmong 486 187 participants, the incidence of any VHD was 16 per 10 000 person-years, with highest rates for MR (8.2), AS (7.2) and AR (5.0). Age, heart failure, coronary artery disease and atrial fibrillation were significantly associated with all types of VHD. In our adjusted model, aortic and mitral VHD had an increased risk of all-cause death compared with no VHD (HR 1.62, 95% CI 1.44 to 1.82, p<0.001 and HR 1.25, 95% CI 1.09 to 1.44, p=0.002 for aortic and mitral VHD, respectively).ConclusionVHD continues to constitute a significant public health burden, with MR and AS being the most common. Age and cardiac comorbidities remain strong risk factors for VHD. In the modern era of percutaneous and surgical interventions, mortality associated with VHD remains high.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Valvular disease burden in the modern era of percutaneous and surgical interventions: the UK Biobank

et al. 2022

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“…Aortic stenosis (AS) is common in the elderly with an increasing number of patients as our population ages but precise estimates of prevalence have been limited by inadequate diagnostic data in most clinical databases. In this issue of Heart, Owens and colleagues 1 performed a targeted review of medical records for 5795 participants over age 65 years in the population based Cardiovascular Health Study to determine the frequency of moderate to severe AS. Over 25 years, the cumulative frequency of significant AS was 3.7% with 85% of these patients being hospitalised for severe AS, although only ½ underwent aortic valve replacement.…”

Section: Catherine M Ottomentioning

confidence: 99%

Heartbeat: prevalence and treatment of severe aortic stenosis in older patients

Otto

2021

Heart

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“…Aortic stenosis (AS) disease is one of the most common valvular diseases associated with age [ 1 , 2 ]. Over the past 30 years, the global prevalence of calcific aortic valve disease-associated deaths has increased [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Measures of high-density lipoprotein function in men and women with severe aortic stenosis

2022

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Background Calcification of the aortic valve is a common heart valve disorder, in some cases leading to clinically impactful severe aortic stenosis (AS). Sex-specific differences in aortic valve calcification (ACV) exist, with women having a lower burden of calcification than men as measured by computed tomography; however, the pathophysiological mechanism that leads to these differences remains unclear. Methods Using cultured human Tamm-Horsfall protein 1 (THP-1) macrophages and human aortic valve interstitial cells, the effects of high-density lipoprotein (HDL) particles isolated from the plasma of men and women with severe AS were studied for cholesterol efflux capacity (CEC). Results HDL-CEC was assessed in 46 patients with severe AS, n = 30 men, n = 16 women. ATP-Binding Cassette A1 (ABCA1)-mediated HDL-CEC was measured from human cultured THP-1 macrophages to plasma HDL samples. Women with severe AS had more ABCA1-mediated HDL-CEC, as compared to men (8.50 ± 3.90% cpm vs. 6.80 ± 1.50% cpm, P = 0.04). HDL pre-β1 and α-particles were higher in woman than in men by spectral density, (pre-β1 HDL, 20298.29 ± 1076.15 vs. 15,661.74 ± 789.00, P = 0.002, and α-HDL, 63006.35 ± 756.81 vs. 50,447.00 ± 546.52, P = 0.03). Lecithin-cholesterol acyltransferase conversion of free cholesterol into cholesteryl esters was higher in women than men (16.44 ± 9.11%/h vs. 12.00 ± 8.07%/h, P = 0.03). Conclusions Sex-specific changes in various parameters of HDL-CEC were found in patients with severe AS. Sex-based modifications in HDL functionality by HDL-CEC might account for the reduced burden of calcification in women vs. men with severe AS. Therefore, future studies should target sex-related pathways in AS to help to improve understanding and treatment of AS. Graphical abstract Sex specifc differences in AVC and differences associated with HDL function in men and women with severe AS. When compared to men, women had higher preβ-HDL and α-HDL migrating particles, higher cholesterol efflux to HDL, and higher lecithin cholesterol acyl transferase (LCAT) activity, possibly indicating that improved reverse cholesterol transport may be protective against worsened calcification.

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Cumulative burden of clinically significant aortic stenosis in community-dwelling older adults

Cited by 26 publications

References 32 publications

Valvular disease burden in the modern era of percutaneous and surgical interventions: the UK Biobank

Valvular disease burden in the modern era of percutaneous and surgical interventions: the UK Biobank

Heartbeat: prevalence and treatment of severe aortic stenosis in older patients

Measures of high-density lipoprotein function in men and women with severe aortic stenosis

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