Assessment of risk factors for developing incident aortic stenosis: the Tromsø Study

Abstract

To disclose risk factors of incident aortic stenosis (AS) and progression of established AS. A prospective cohort study. The Tromsø Study, a population based health survey. Over a 14 years span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3,243 participants. Data from the only hospital serving this population were included in the follow up. Throughout the study 132 participants were diagnosed with incident AS, defined as mean aortic valve gradient ≥15 mmHg. Cox proportional hazards regression disclosed age (HR 1.11, 95 %CI 1.08-1.14), systolic blood pressure (BP) (HR 1.01, 95 % CI 1.00-1.02), active smoking (HR 1.71, 95 % CI 1.09-2.67), and waist circumference (HR 1.02, 95 % CI 1.00-1.03) as independent predictors of incident AS. Analysis of risk factors for progression of AS disclosed a higher mean aortic gradient at first measurement (p = 0.015), weight (p = 0.015), a low haemoglobin (Hgb) (p = 0.030) and high density lipoprotein (HDL) (p = 0.032) as significant independent predictors. Age, systolic BP, smoking and waist circumference were independent predictors of incident AS, whereas cholesterol was not. Mean aortic gradient at first measurement, weight, an elevated HDL and low Hgb increase the progression rate of the disease. Our data indicate that calcific aortic valve disease is a distinct pathophysiological process, with age, smoking and "wear and tear" of the valve being major contributors to the disease development.

Type 1 and type 2 diabetes mellitus and incidence of seven cardiovascular diseases

“…That study did not adjust for BMI, which was a strong confounder of the association between T2DM and aortic valve stenosis in our study, and a risk factor for aortic valve stenosis [17]. In two smaller prospective studies, DM was associated with an approximately 3-fold increased risk of aortic valve stenosis in a cohort of 5079 Swedish adults (including 69 cases in the whole cohort) [18] but was not associated with risk of aortic valve stenosis in a cohort of 3243 Norwegian adults, possibly because of lack of power with only 6 cases among DM patients [19]. None of the above mentioned reports specified the type of DM.…”

Physical Activity Does Not Reduce Aortic Valve Stenosis Incidence

“…1 We observed a barely significant increase in AVS risk among participants who exercised ≥1 h/day, which should be interpreted as a statistical anomaly as there were no significant differences in AVS incidence in the other categories.…”

“…n the Western world, aortic valve stenosis (AVS) is the most prevalent form of valvular heart disease, 1 and is associated with high morbidity and death from cardiovascular disease. As no medical treatments for AVS have proved to be efficacious in slowing down progression, it is of great importance to identify lifestyle factors that can prevent the development of the condition.…”

“…7 However, studies of the potential role of physical activity for the prevention of AVS are scarce. 1 The aim of this study was therefore to establish whether physical activity reduces the risk of AVS.…”

Echocardiographic consequences of smoking status in middle‐aged subjects

“…Worldwide more than one in 10 cardiovascular deaths in the year 2000 were attributable to smoking . Smoking is a risk factor not only for coronary artery disease, but also for left ventricular failure, aortic valve stenosis, left ventricular hypertrophy, and atrial fibrillation . Smoking is also a leading cause of chronic obstructive pulmonary disease (COPD), and cardiovascular disease is well known to be a common comorbidity in patients with COPD .…”