Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 23:jeaf279.
doi: 10.1093/ehjci/jeaf279. Online ahead of print.

Impact of Age on Aortic Valve Calcium Progression and Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis

Natalie Marrero  1 , Kunal Jha  2 , Jelani Grant  3 , Alexander C Razavi  4 , Matthew J Budoff  5 , Sanjiv J Shah  6 , Jerome I Rotter  7 , Roger S Blumenthal  3 , Wendy S Post  3 , Leslee J Shaw  8 , George Thanassoulis  9 , Michael J Blaha  3 , Seamus P Whelton  3
Affiliations

Impact of Age on Aortic Valve Calcium Progression and Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis

Natalie Marrero et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Background: Aortic valve calcium (AVC) is strongly associated with the risk for severe aortic stenosis (AS). The prevalence of AVC increases with age, but the impact of age on the progression of AVC and its association with moderate-severe AS is unknown.

Methods: Our study included 6,810 participants (52.9% women) without overt cardiovascular disease between ages 45 and 84 from the Multi-Ethnic Study of Atherosclerosis. AVC was measured using non-contrast cardiac CT at Visit 1. Progression was calculated as the change in AVC divided by years between CT scans (2-10 years). Incident moderate-severe AS was adjudicated using medical chart review and echocardiogram data from Visit 6 (median follow-up of 16 years). The association between AVC and moderate-severe AS was assessed using multivariable adjusted Cox proportional hazards ratios.

Results: There were 5,899 participants with AVC =0 and 911 with AVC >0. There were 3,834 participants age <65 years and 2,979 age ≥65 years. The median AVC was 34.1 AU (IQR 13-1,113) for participants <65 versus 69.0 AU (IQR 23-2,453) for participants ≥65. Participants <65 and ≥65 years had no significant difference in median annualized AVC progression within the baseline AVC categories of 1-99 (10 versus 12 AU/year, p=0.303) and AVC ≥100 (50 versus 47 AU/year, p=0.846). AVC >0 was associated with a similar significantly higher risk of incident moderate-severe AS for both younger (HR 13.37; 95% CI 5.67-31.52) and older participants (HR 10.59, 95% CI 6.77-16.56).

Conclusion: AVC progression was significantly associated with baseline AVC burden and was similar for younger versus older persons after accounting for baseline AVC. The presence of AVC was significantly associated with a higher long-term risk for moderate-severe AS among both younger and older participants.

Keywords: Age; Aortic valve calcium; aortic stenosis; cardiac computed tomography; incidence.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors have no relevant conflicts of interest and relationships with industry to disclose.

Figures

Figure 1.
Figure 1.
Age specific incidence of moderate-severe AS by AVC categories per 1,000 person-years follow-up
Figure 2.
Figure 2.
Kaplan-Meier curve: survival free from moderate-severe AS stratified by age and AVC category
Figure 3.
Figure 3.
Association of aortic valve calcium with incident moderate-severe aortic stenosis stratified bv age
CENTRAL ILLUSTRATION:
CENTRAL ILLUSTRATION:
Impact of age on aortic valve calcium progression and risk for aortic stenosis: Multi-Ethnic Study of Atherosclerosis
See this image and copyright information in PMC

Comment in

References

    1. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association, Circulation 2022;145:e153–e639. - PubMed
    1. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association, Circulation 2021;143:e254–e743. - PubMed
    1. Goldsweig AM, Tak HJ, Chen L, Aronow HD, Shah B, Kolte D et al. Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy, Circ Cardiovasc Interv 2020;13:e008681. - PubMed
    1. Généreux P, Head SJ, Van Mieghem NM, Kodali S, Kirtane AJ, Xu K et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies, J Am Coll Cardiol 2012;59:2317–2326. - PubMed
    1. Osnabrugge RLJ, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study, J Am Coll Cardiol 2013;62:1002–1012. - PubMed