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. 2022 May 2;5(5):e2211946.
doi: 10.1001/jamanetworkopen.2022.11946.

Association of Mild Valvular Lesions With Long-term Cardiovascular Outcomes Among Black Adults

Kunihiro Matsushita  1 , Yumin Gao  1 , Jonathan Rubin  2 , Ajay J Kirtane  2 , Susheel Kodali  2 , Elizabeth Selvin  1 , Alvaro Alonso  3 , Martin B Leon  2 , Scott D Solomon  4 , Josef Coresh  1 , Ervin R Fox  5 , Amil M Shah  4
Affiliations

Association of Mild Valvular Lesions With Long-term Cardiovascular Outcomes Among Black Adults

Kunihiro Matsushita et al. JAMA Netw Open. .

Abstract

Importance: Little is known about the long-term outcomes of mild valvular lesions.

Objective: To examine the associations of 3 major types of valvular lesions (aortic stenosis, trace or mild aortic regurgitation, and trace or mild mitral regurgitation) with risk of cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, and atrial fibrillation.

Design, setting, and participants: This cohort study analyzed data from the ongoing Atherosclerosis Risk in Communities study and focused on Black participants in the Jackson, Mississippi, site who underwent echocardiography at visit 3 from 1993 to 1995. Data analysis was conducted between April 2021 and February 2022.

Exposures: Three valvular lesions were analyzed: aortic sclerosis, aortic regurgitation (trace or mild), and mitral regurgitation (trace or mild).

Main outcomes and measures: The outcomes were cardiovascular mortality, coronary heart disease, heart failure, stroke, and atrial fibrillation. Multivariable Cox proportional hazards regression models were used to examine the independent associations between the 3 valvular lesions and these outcomes.

Results: A total of 2106 Black participants were included, with a mean (SD) age of 59.1 (5.6) years and 1354 women (64.3%). The baseline prevalence was 7.7% for aortic sclerosis, 15.1% for aortic regurgitation (6.1% with trace, and 9.0% with mild), and 43.0% for mitral regurgitation (29.4% with trace, and 13.6% with mild). During a median (interquartile interval) follow-up of 22.5 (15.6-23.5) years, 890 participants developed at least 1 cardiovascular outcome. Each valvular lesion was significantly associated with at least 1 cardiovascular outcome: aortic sclerosis was associated with cardiovascular mortality (adjusted hazard ratio [HR], 1.54; 95% CI, 1.06-2.22), mild mitral regurgitation was associated with atrial fibrillation (HR, 1.47; 95% CI, 1.09-1.99), and trace or mild aortic regurgitation was associated with all outcomes (HRs ranging from 1.45 [95% CI, 1.17-1.81] to 1.75 [95% CI, 1.29-2.37]) except stroke. The total number of valvular lesions had graded associations with all cardiovascular outcomes except stroke: the HR of cardiovascular mortality was 1.77 (95% CI, 1.18-2.65) for those with 2 to 3 lesions and was 1.44 (95% CI, 1.05-1.96) for those with 1 lesion vs no lesions.

Conclusions and relevance: Results of this study indicate an association between valvular lesions, even at mild stage, and a long-term risk of cardiovascular events, suggesting the importance of recognizing and monitoring these valvular conditions.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Matsushita reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Kirtane reported receiving research grants and institutional funding to Columbia University and/or Cardiovascular Research Foundation (for consulting and/or speaking engagements in which Dr Kirtane controlled the content) from Medtronic, Boston Scientific, Abbott Vascular, Amgen, CSI, Philips, ReCor Medical, Neurotronic, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, and SoniVie and receiving personal fees for consulting and travel expenses/meals from IMDS, Medtronic, Boston Scientific, Abbott Vascular, CSI, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Dr Kodali reported receiving grants from Edwards Lifesciences, Medtronic, JenaValve, Boston Scientific, Abbott Vascular; other (equity—consultant) from Thubrikar Aortic Valve Inc, Dura Biotech, TriFlo, and MicroInterventional Devices; and personal fees from Tricares, ShifaMed Companies, and Admedus outside the submitted work. Dr Selvin reported receiving grants from the NIH and Foundation for the National Institutes of Health during the conduct of the study and outside the submitted work. Dr Alonso reported receiving grants from the NIH outside the submitted work. Dr Leon reported receiving grants from Abbott, BSC, Edwards, and Medtronic. Prof Solomon reported receiving grants to his institution from Actelion; Alnylam; Amgen; AstraZeneca; Bellerophon; Bayer; Bristol Myers Squibb; Celladon; Cytokinetics; Eidos; Gilead; GlaxoSmithKline; Ionis; Lilly; Mesoblast; MyoKardia; the National Heart, Lung, and Blood Institute of the NIH (NIH/NHLBI); Neurotronik; Novartis; NovoNordisk; Respicardia; Sanofi; Theracos; and US2.AI; and personal fees for consulting from Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer-Ingelheim, Bristol Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, Sarepta, Lexicon, Anacardio, Akros, and PureHealth outside the submitted work. Prof Coresh reported receiving grants from the NIH during the conduct of the study, grants from the National Kidney Foundation, and serving as a consultant for and receiving stock options from Healthy.io outside the submitted work. Dr Shah reported receiving grants from the NIH/NHLBI, other support from Novartis through Brigham and Women's Hospital, and personal fees for advisory board service from Philips Ultrasound and Janssen outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Survival Estimates Free of Cardiovascular Disease (CVD) Death by Individual Valvular Lesions
Cardiovascular mortality was defined as death from coronary heart disease, stroke, or heart failure.
Figure 2.
Figure 2.. Kaplan-Meier Survival Estimates Free of Cardiovascular Disease Death by Number of Valvular Lesions
Valvular lesions were defined as aortic sclerosis, trace or mild aortic regurgitation, and mild mitral regurgitation, based on their independent associations with cardiovascular disease death. Cardiovascular mortality was defined as death from coronary heart disease, stroke, or heart failure.
See this image and copyright information in PMC

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