Cardiovascular risk factors and aortic valve calcification: what do these associations mean?

Aortic valve disease is the most prevalent valvular heart disease around the world, with degenerative aortic valve disease the most common aetiology in high-income countries. Both degenerative aortic valve disease and coronary artery disease share pathological features. In particular, the early stages of aortic stenosis, referred to as the initiation phase, demonstrate endothelial damage, lipid infiltration and inflammation leading to early valve fibrosis and calcification. It is perhaps therefore not surprising that risk factors for atherosclerosis have also been associated with incident aortic stenosis. Khurrami et al present the results of the Danish cardiovascular screening trials (DANCAVAS I and II).1 They assessed a large cohort of 14 073 healthy men aged 60–74 years old, who were randomly selected from the Danish population. Calcification in the aortic valve and coronary arteries was assessed on non-contrast CT and associations with a variety of cardiovascular risk factors were investigated. In this asymptomatic elderly male population, aortic valve calcification was identified in 58% and coronary artery calcification identified in 83%. This high prevalence of disease is likely due to the age and gender of this cohort, with older patients having higher aortic valve calcium scores. Patients with more cardiovascular risk factors were more likely to have aortic valve calcification and had higher aortic valve calcium scores. In a multivariable analysis which included the presence of severe coronary artery calcification (>400 Agatston units, AU), only age, obesity, history of cerebrovascular disease and serum phosphate …