Key result
Aortic valve calcium is linked to ~91% higher risk of incident aortic stenosis across sexes.
Why the study?
Females have lower AVC scores than males of similar age and a lower AVC threshold for severe AS diagnosis, but sex differences in AVC's prognostic value for AS risk are unclear.
Does the prognostic value of aortic valve calcium for predicting long-term incident aortic stenosis differ between females and males?
Cohort (n=6,810)
Yes
Does the prognostic value of aortic valve calcium for predicting long-term incident aortic stenosis differ between females and males?
Aortic valve calcium score strongly predicts the long-term risk of incident moderate-to-severe aortic stenosis equally in both females and males, suggesting sex-specific thresholds may not be needed for long-term risk estimation despite being necessary for severe AS diagnosis.
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Similar aortic valve calcium–aortic stenosis association in both sexes supports uniform long-term risk thresholds; leaves open need for sex-specific validation in prospective studies.
Background: In general, females have lower aortic valve calcium (AVC) scores compared with males of similar age, and the AVC score threshold for diagnosing severe aortic stenosis (AS) is lower for females. We examined whether the association of AVC with the long-term risk of clinically significant AS differed for females compared with males. Methods: AVC was measured using cardiac computed tomography among 6810 MESA (Multi-Ethnic Study of Atherosclerosis) participants. We examined AVC as a continuous (ln [AVC+1]) and categorical variable (0, 1–99, 100–299, ≥300 AU). Incident moderate or severe AS was adjudicated using standard clinical criteria with a median follow-up of 16 years. The association between AVC and AS was examined using multivariable-adjusted Cox proportional hazards regression. Results: Females comprised 52.9% of participants, with AVC >0 present among 10.1% of females and 17.0% of males. There were 65 cases of incident AS in females and 75 in males. AVC as a continuous variable was associated with a higher risk of incident AS for females (hazard ratio, 1.91 [95% CI, 1.68–2.16]) and males (hazard ratio, 2.13 [95% CI, 1.88–2.41]). There was no interaction between AVC and sex ( P =0.31) for their association with AS. Females and males had similar adjusted hazards for incident AS across AVC categories, and for those with AVC ≥300, the hazard ratio was 134.9 (95% CI, 45.1–403.9) for females and 132.8 (95% CI, 6.2–274.9) for males. Conclusions: The association of AVC with the long-term risk of incident AS was similar for females and males, further supporting the utility of AVC as a prognostic marker for incident AS.
Marrero et al. (2026) conducted a cohort in Aortic Stenosis (n=6,810). Aortic valve calcium vs. Lower or absent aortic valve calcium was evaluated on Incident moderate or severe aortic stenosis (HR 1.91, 95% CI 1.68-2.16, p=0.31 for interaction). Aortic valve calcium was associated with a similarly increased long-term risk of incident moderate or severe aortic stenosis for both females (HR 1.91) and males (HR 2.13).
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