Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Abstract

BackgroundThe relationship between ideal cardiovascular health reflected in the cardiovascular health score (CVHS) and valvular heart disease is not known. The purpose of this study was to determine the association of CVHS attainment through midlife to late life with aortic stenosis prevalence and severity in late life.Methods and ResultsThe following 6 ideal cardiovascular health metrics were assessed in ARIC (Atherosclerosis Risk in Communities) Study participants at 5 examination visits between 1987 and 2013 (visits 1–4 in 1987–1998 and visit 5 in 2011–2013): smoking, body mass index, total cholesterol, blood pressure, physical activity, and blood glucose. Percentage attained CVHS was calculated in 6034 participants as the sum of CVHS at each visit/the maximum possible score. Aortic stenosis was assessed by echocardiography at visit 5 on the basis of the peak aortic valve velocity. Aortic stenosis was categorized sclerosis, mild stenosis, and moderate‐to‐severe stenosis. Mean age was 76±5 years, 42% were men, and 22% were black. Mean percentage attained CVHS was 63±14%, and the prevalence of aortic stenosis stages were 15.9% for sclerosis, 4.3% for mild stenosis, and 0.7% for moderate‐to‐severe stenosis. Worse percentage attained CVHS was associated with higher prevalence of aortic sclerosis (P<0.001 for trend), mild stenosis (P<0.001), and moderate‐to‐severe stenosis (P=0.002), adjusting for age, sex, and race.ConclusionsGreater attainment of ideal cardiovascular health in midlife to late life is associated with a lower prevalence of aortic sclerosis and stenosis in late life in a large cohort of older adults.

Ideal cardiovascular health metrics and the risk of non‐alcoholic fatty liver disease: A cross‐sectional study in northern China

“…The concept consists of 4 ideal health behaviours (not smoking, body mass index (BMI) <25 kg/m 2 , physical activity at goal levels and a diet consistent with current guideline recommendations) and 3 ideal health factors (total cholesterol [TC], blood pressure and fasting blood glucose) . The negative association of ideal CVH metrics and the prevalence of CVD has been reported previously . The risks of atherosclerotic plaque or coronary artery calcium were each reduced by approximately 60% in subjects with 6 or 7 ideal factors compared to 0 to 2 ideal factors in a prospective cohort study .…”

“…7 The negative association of ideal CVH metrics and the prevalence of CVD has been reported previously. 6,8 The risks of atherosclerotic plaque or coronary artery calcium were each reduced by approximately 60% in subjects with 6 or 7 ideal factors compared to 0 to 2 ideal factors in a prospective cohort study. 6 Our previous study based on the Jidong community indicated that the participants in the highest ideal CVH metrics summary score quartile had a 71% decreased prevalence of extracranial carotid artery stenosis (CAS) compared to those in the lowest summary score quartile.…”

The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?

“…Cancer also occurs more frequently with advancing age [6] and has a major impact on mortality. In the Atherosclerosis Risk in Communities (ARIC) Trial, the presence of ideal cardiovascular health markers in midlife (smoking, body mass index, total cholesterol, blood pressure, physical activity, and blood glucose) was associated with a lower incidence of both AS and cancer after 75 years of age [4,7]. These results highlight not only the age-dependency, but also common predisposing factors for cancer and cardiovascular disease.…”

“…The prevalence of heart valve calcifications increases with age [1] and their presence is associated with a poor prognosis [2]. Calcific aortic stenosis (AS) is a common condition of the elderly [3], caused by progressive atherosclerosis and structural valve degeneration due to inflammation, fibrosis, and calcification related to traditional cardiovascular risk factors [4]. The latter is the main driver of atherosclerotic cardiovascular disease in elderly populations [5].…”

Differences at surgery between patients with bicuspid and tricuspid aortic valves

“…The Cardiovascular Health Study and the CANHEART Aortic Stenosis Study demonstrated that the well-known cardiovascular risk factors age, male gender, hypertension, smoking, dyslipidaemia and diabetes were associated with the development and progression of AS [ 5 , 6 ]. Additionally, greater attainment of ideal cardiovascular health in midlife to later life was associated with a lower prevalence of AS in late life [ 7 ]. These results are often extrapolated to BAV stenosis.…”