Prevalence and common cardiovascular risk factors in aortic valve calcification in the middle-aged general population

Abstract

Aims: Aortic valve calcification (AVC) is an underlying pathophysiological mechanism for aortic stenosis that is common in the elderly, but less is known in younger individuals. The aim was to study the prevalence and associated characteristics of AVC in a middle-aged general population.

Methods and results: Data were obtained from the Swedish CArdioPulmonary bioImage Study (SCAPIS) comprising 30 154 individuals 50-64 years from the general population recruited in Sweden between 2013 and 2018. Aortic valve calcification was assessed visually on computed tomography (CT) and categorized as evident or not. Population attributable risk proportion (PARP) was calculated for six modifiable risk factors (smoking, hypertension, hyperlipidaemia, diabetes, body mass index (BMI) ≥ median, and kidney dysfunction [estimated glomerular filtration rate < 60 mL/min/1.73 m2]). In total, 29 221 individuals with CT images available were included (mean age 57.5 years, 51% female) and AVC was present in 2053 (7%). The AVC prevalence increased with age (50-54 years: 3%; 55-59 years: 7%; 60-64 years: 11%). In analyses adjusted for age, sex, smoking, and study site, male sex (OR 2.02, 95% CI 1.84-2.22), hyperlipidaemia (1.88 [1.68-2.11]), hypertension (1.73 [1.57-1.91]), diabetes (1.66 [1.39-1.97]), kidney dysfunction (1.54 [1.10-2.11]), smoking (1.36 [1.24-1.50]), age (increment by one year) (1.12 [1.11-1.13]), and BMI (increment by one unit) (1.04 [1.03-1.05]) were associated with AVC. The PARP of AVC associated with the six modifiable risk factors was 34.5% (95% CI 29.6-39.4).

Conclusion: In this large, contemporary middle-aged general population, AVC was prevalent in as many as 7% and six cardiovascular risk factors contributed to one-third of the prevalence of AVC.

Lay summary: Aortic valve calcification (AVC) is an underlying pathophysiological mechanism for aortic stenosis, the most common valvular heart disease requiring intervention in developed countries. Aortic valve calcification is common in the elderly but less is known in younger individuals. We therefore sought to examine the prevalence and associated characteristics of AVC among the middle-aged population using the Swedish CardioPulmonary BioImage Study (SCAPIS), comprising 30 154 randomly selected men and women aged 50-64 years. Study participants underwent cardiac computed tomography for the assessment of AVC.Aortic valve calcification was concerningly common in the middle-aged population at 3, 7, and 11% among the age groups 50-54, 55-59, and 60-64 years, respectively. Moreover, AVC was found more frequently among those with cardiovascular risk factors or established cardiovascular disease. Six common and modifiable cardiovascular risk factors (smoking, hypertension, hyperlipidaemia, diabetes, body mass index, and kidney dysfunction) contributed to approximately a third of AVC cases.Given that a substantial proportion of middle-aged individuals are affected with AVC, the study results may serve as a basis for future screening initiatives for a subgroup of individuals at highest risk in the general population. Furthermore, this emphasizes the potential of optimizing risk factor management to reduce the burden of AVC.

Keywords: Aortic stenosis; Aortic valve calcification; Cardiovascular prevention; Epidemiology; Hyperlipidaemia; Hypertension; Prevention.