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Multicenter Study
. 2024 Oct:397:117596.
doi: 10.1016/j.atherosclerosis.2024.117596. Epub 2024 May 27.

Association of aortic valve calcium with dementia and stroke: The Multi-Ethnic Study of Atherosclerosis

Natalie Marrero  1 , Kunal Jha  2 , Timothy M Hughes  3 , Alexander C Razavi  4 , Jelani K Grant  5 , Ellen Boakye  5 , Khalil Anchouche  6 , Omar Dzaye  5 , Matthew J Budoff  7 , Jerome I Rotter  8 , Xiuqing Guo  8 , Jie Yao  8 , Alexis C Wood  9 , Roger S Blumenthal  5 , Erin D Michos  5 , George Thanassoulis  6 , Wendy S Post  5 , Michael J Blaha  5 , Chinwe Ibeh  10 , Seamus P Whelton  11
Affiliations
Multicenter Study

Association of aortic valve calcium with dementia and stroke: The Multi-Ethnic Study of Atherosclerosis

Natalie Marrero et al. Atherosclerosis. 2024 Oct.

Abstract

Background and aims: Calcific aortic valve disease is associated with increased thrombin formation, platelet activation, decreased fibrinolysis, and subclinical brain infarcts. We examined the long-term association of aortic valve calcification (AVC) with newly diagnosed dementia and incident stroke in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: AVC was measured using non-contrast cardiac CT at Visit 1. We examined AVC as a continuous (log-transformed) and categorical variable (0, 1-99, 100-299, ≥300). Newly diagnosed dementia was adjudicated using International Classification of Disease codes. Stroke was adjudicated from medical records. We calculated absolute event rates (per 1000 person-years) and multivariable adjusted Cox proportional hazards ratios (HR).

Results: Overall, 6812 participants had AVC quantified with a mean age of 62.1 years old, 52.9 % were women, and the median 10-year estimated atherosclerotic cardiovascular disease (ASCVD) risk was 13.5 %. Participants with AVC >0 were older and less likely to be women compared to those with AVC=0. Over a median 16-year follow-up, there were 535 cases of dementia and 376 cases of stroke. The absolute risk of newly diagnosed dementia increased in a stepwise pattern with higher AVC scores, and stroke increased in a logarithmic pattern. In multivariable analyses, AVC was significantly associated with newly diagnosed dementia as a log-transformed continuous variable (HR 1.09; 95 % CI 1.04-1.14) and persons with AVC ≥300 had nearly a two-fold higher risk (HR 1.77; 95 % CI 1.14-2.76) compared to those with AVC=0. AVC was associated with an increased risk of stroke after adjustment for age, sex, and race/ethnicity, but not after adjustment for ASCVD risk factors.

Conclusions: After multivariable adjustment, AVC >0 was significantly associated with an increased risk of newly diagnosed dementia, but not incident stroke. This suggests that AVC may be an important risk factor for the long-term risk of dementia beyond traditional ASCVD risk factors.

Keywords: Aortic stenosis; Aortic valve calcium; Cardiac CT; Cerebrovascular event; Dementia; Epidemiology; Stroke.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Burden of AVC for persons with and without newly diagnosed dementia or incident stroke.
Figure 2a and 2b:
Figure 2a and 2b:
Absolute event rate (per 1,000 person-years) of stroke and newly diagnosed dementia stratified by AVC groups 0, 1–99, 100–299, ≥ 300 AU *p for trend <0.01 for both graphs
See this image and copyright information in PMC

Comment in

  • The aortic valve as a window to dementia.
    Patel Y, Hulten EA. Patel Y, et al. Atherosclerosis. 2024 Sep;396:118542. doi: 10.1016/j.atherosclerosis.2024.118542. Epub 2024 Jul 11. Atherosclerosis. 2024. PMID: 39111027 No abstract available.

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