Predictors of Coronary and Carotid Atherosclerosis in Patients with Severe Degenerative Aortic Stenosis

Abstract

Background. Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS.Methods. We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22).Results. The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%).Conclusions. In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical “survival bias”, i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis.

Sex, Race, and Socioeconomic Disparities in Patients With Aortic Stenosis (from a Nationwide Inpatient Sample)

“…1,2 Although considered a degenerative disorder typically affecting the elderly people, AS has gained importance in recent years because of population aging. 1–3 AS prevalence in subjects ≥65 years was estimated at 2% to 7%, with 5.5% of subjects >85 years diagnosed with AS 1–3 ; each year, ~22,000 deaths were attributed to valvular disease in the United States, with AS being particularly problematic because it carries a high mortality risk once symptoms have appeared. Furthermore, the multifactorial etiology of AS points to prominent roles played by traditional cardiovascular risk factors such as male gender, advanced age, smoking, hypertension, hypercholesterolemia, diabetes, metabolic syndrome, and atherosclerosis.…”

“…Furthermore, the multifactorial etiology of AS points to prominent roles played by traditional cardiovascular risk factors such as male gender, advanced age, smoking, hypertension, hypercholesterolemia, diabetes, metabolic syndrome, and atherosclerosis. 3–6 The equitable distribution of health care resources requires a better understanding of the epidemiology of AS, whereas identifying subgroups within the general population at high risk for AS. Previous research suggested that most AS-affected subjects (~70%) are >60 years, with a balanced gender ratio.…”

Prevalence and Dynamics of Endothelial Dysfunction, Carotid and Coronary Atherosclerosis in Patients With Chronic Rheumatic Heart Disease

“…При этом митральный стеноз при том же функциональном классе ХСН, что и АС, вносит меньший вклад в развитие ЭД и атеросклероза артерий, особенно коронарных. И хотя в литературе доказывается высокая степень взаимосвязи между каротидным, коронарным атеросклерозом и АС [5,6,8], механизм происходящих в клапане и в сосудистой стенке процессов различается. И если частота коронарного атеросклероза для обследованных с ХРБС (33,3 %) и АС О р и г и н а л ь н ы е и с с л е д о в а н и я (52,5 %) оказалась сопоставимой с описанной в литературе [7], то частота каротидного атеросклероза у пациентов с ХРБС (слева -72,3 %, справа -68,08 %) и АС (слева -93,2 %, справа -90,9 %) была значительно выше, чем по данным других исследований [5,6].…”

“…При этом пациенты с митральной и аортальной недостаточностью занимают «промежуточную» позицию с частотой коронарного атеросклероза от 41,9 до 44,4 % соответственно [7]. При этом в ряде работ отмечается снижение распространенности атеросклероза коронарных артерий у женщин старше 76 лет с выраженным АС [8]. Основное внимание в литературе уделено возможной взаимосвязи АС и атеросклероза коронарных артерий [9,10].…”

Prevalence of endothelial dysfunction and dyslipidemia in patients with chronic rheumatic heart disease

“…Вместе с тем в ряде работ отмечается снижение частоты атеросклероза коронарных артерий в группе женщин с аортальным стенозом старше 76 лет [9]. Однако основное внимание в литературе уделяется оценке взаимосвязи приобретенного аортального стеноза и атеросклероза коронарных артерий [10,11].…”