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

Abstract

Background: The 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 results: The 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.

Conclusions: Greater 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.

Keywords: aortic stenosis; echocardiography; epidemiology; primary prevention; risk factor.

Figure 1

Distribution of aortic valve peak velocity among ARIC (Atherosclerosis Risk in Communities) Study participants at visit 5. Colors signify categories of aortic valve function: normal (green), aortic sclerosis (navy), mild stenosis (red), and moderate‐to‐severe stenosis (purple).

Figure 2

Continuous relationship between percentage attained cardiovascular health score (CVHS) from midlife to late life and late life aortic valve peak velocity (A) and aortic valve area (AVA; B). BSA indicates body surface area.

Figure 3

Relationship between categories on the basis of attained cardiovascular health score (CVHS) in midlife through late life and presence of aortic valve dysfunction in late life. A, Prevalence of aortic sclerosis, mild stenosis, and moderate‐to‐severe stenosis in late life (visit 5) among categories on the basis of percentage attained CVHS from midlife to late life (visits 1 through 5). B, Odds of aortic sclerosis, mild stenosis, and moderate‐to‐severe stenosis in late life (visit 5) among categories of percentage attained CVHS relative to the lowest category of attained CVHS (<50%). P for trend across categories is adjusted for age, sex, race, and field center. Odds ratios are adjusted for age, sex, race, and field center.

Figure 4

Prevalence of late‐life (visit 5) aortic valve (AV) peak velocity over 1.5 m/s (A) and 2.0 m/s (B), on the basis of category of percentage attained cardiovascular health score through midlife to late life (from visits 1 through 5) and participant age at visit 5.

Figure 5

Trajectories of cardiovascular health score (CVHS) and aortic valve dysfunction. A, Trajectories of percentage cumulative CVHS in the ARIC (Atherosclerosis Risk in Communities) Study. Percentages in the figure legend refer to population prevalence. B, Prevalence of aortic sclerosis and mild or greater stenosis by trajectory of CVHS. Prevalence estimates and P values are adjusted for age, sex, race, and field center. NS indicates not significant. Reprinted from Shah et al18 with permission. Copyright© 2015, American Heart Association, Inc.