Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case–Referent Study

Abstract

BackgroundRisk factors for developing heart valve and ascending aortic disease are based mainly on retrospective data. To elucidate these factors in a prospective manner, we have performed a nested case–referent study using data from large, population‐based surveys.Methods and ResultsA total of 777 patients operated for heart valve disease or disease of the ascending aorta had previously participated in population‐based health surveys in Northern Sweden. Median time (interquartile range) from survey to surgery was 10.5 (9.0) years. Primary indications for surgery were aortic stenosis (41%), aortic regurgitation (12%), mitral regurgitation (23%), and dilatation/dissection of the ascending aorta (17%). For each case, referents were allocated, matched for age, sex, and geographical area. In multivariable models, surgery for aortic stenosis was predicted by hypertension, high cholesterol levels, diabetes mellitus, and active smoking. Surgery for aortic regurgitation was associated with a low cholesterol level, whereas a high cholesterol level predicted surgery for mitral regurgitation. Hypertension, blood pressure, and previous smoking predicted surgery for disease of the ascending aorta whereas diabetes mellitus was associated with reduced risk. After exclusion of cases with coronary atherosclerosis, only the inverse associations between cholesterol and aortic regurgitation and between diabetes mellitus and disease of the ascending aorta remained.ConclusionsThis is the first truly prospective study of traditional cardiovascular risk factors and their association with valvular heart disease and disease of the ascending aorta. We confirm the strong association between traditional risk factors and aortic stenosis, but only in patients with concomitant coronary artery disease. In isolated valvular heart disease, the impact of traditional risk factors is varying.

Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis

“…The suggestion of a sex-related difference in the association between a low ratio and AVR is intriguing and has not been described previously as related to other cardiovascular outcomes and mortality. We found no sex-related differences related to traditional and biochemical risk-markers (lipoprotein(a), Apo B and Apo A1) in our previous reports based on the same cohort [12,13]. There may be sex-related differences in the vulnerability for traditional risk-markers [29], and we and others have shown differences related to circulating levels and prognostic ability of the adipokine leptin, which also affects endothelial function and relates to AS [30,31].…”

“…Several of the traditional cardiovascular risk factors have been attributed to the development of AS but most of the early studies were small, cross-sectional and biased regarding inclusion criteria as stated by Stewart et al [17]. Recently, we reported an association between traditional cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia and smoking) and the risk for future surgery for AS in the present cohort, and this risk was mainly seen in those with concomitant CAD [13]. This was recently confirmed in a large Canadian study [18] of elderly individuals, not stratified for CAD.…”

“…We have recently described clinical examinations and biochemical analysis performed at baseline in this cohort [12,13]. Participants in VIP and MONICA were asked to complete a health questionnaire regarding their living conditions and cardiovascular risk factors.…”

Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease

“…Previously, the pathological process of valvular calcification was regarded as a passive degenerative process, but currently it is regarded as an active biological process, with histological evidence of inflammation and extracellular matrix remodeling that leads to bone formation. Hypercholesterolemia is associated with AS development,2 but randomized trials that targeted a reduction in plasma cholesterol levels have failed to show any effect on progression rates, possibly due to advanced disease and unfavorable changes in the lipid profile 3, 4, 5. However, the atherogenic profile may be better described with measurements of apolipoproteins and lipoprotein(a) [Lp(a)] 6, 7…”

Assessment of Aortic Elasticity and the Doppler Tissue Echocardiography in Thalassemia Major Children

“…2 The parameters are the consequence of regular maturing and natural aging that might be affected by numerous components of hereditary inclination and cardiovascular hazard factors such as blood vessel hypertension, hypercholesterolemia, diabetes mellitus, smoking, and physical movement. 3 They are early signs of structural and functional changes of the vessel wall and an independent predictor of cardiovascular disorders that arise as a consequence of arteriosclerosis. 2 Many studies have been conducted about the aortic elastic changes due to various diseases.…”