Key result
Traditional CV risk factors fail to predict aortic stenosis surgery after excluding concurrent coronary atherosclerosis.
Why the study?
Do traditional cardiovascular risk factors predict future surgery for valvular heart disease or ascending aortic disease?
Case-Control (n=777)
Do traditional cardiovascular risk factors predict future surgery for valvular heart disease or ascending aortic disease?
Traditional cardiovascular risk factors strongly predict future surgery for aortic stenosis primarily in patients with concomitant coronary artery disease, while their impact varies in isolated valvular heart disease.
Questions independent role of traditional risk factors in isolated aortic stenosis surgery; leaves open mechanisms in valvular disease without CAD.
BACKGROUND: Risk factors for developing heart valve and ascending aortic disease are based mainly on retrospective data. To elucidate these factors in a prospective manner, we have performed a nested case-referent study using data from large, population-based surveys. METHODS AND RESULTS: A total of 777 patients operated for heart valve disease or disease of the ascending aorta had previously participated in population-based health surveys in Northern Sweden. Median time (interquartile range) from survey to surgery was 10.5 (9.0) years. Primary indications for surgery were aortic stenosis (41%), aortic regurgitation (12%), mitral regurgitation (23%), and dilatation/dissection of the ascending aorta (17%). For each case, referents were allocated, matched for age, sex, and geographical area. In multivariable models, surgery for aortic stenosis was predicted by hypertension, high cholesterol levels, diabetes mellitus, and active smoking. Surgery for aortic regurgitation was associated with a low cholesterol level, whereas a high cholesterol level predicted surgery for mitral regurgitation. Hypertension, blood pressure, and previous smoking predicted surgery for disease of the ascending aorta whereas diabetes mellitus was associated with reduced risk. After exclusion of cases with coronary atherosclerosis, only the inverse associations between cholesterol and aortic regurgitation and between diabetes mellitus and disease of the ascending aorta remained. CONCLUSIONS: This is the first truly prospective study of traditional cardiovascular risk factors and their association with valvular heart disease and disease of the ascending aorta. We confirm the strong association between traditional risk factors and aortic stenosis, but only in patients with concomitant coronary artery disease. In isolated valvular heart disease, the impact of traditional risk factors is varying.
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Ljungberg et al. (2017) conducted a case-control in Valvular heart disease or ascending aortic disease (n=777). Traditional cardiovascular risk factors vs. Matched referents was evaluated on Surgery for valvular heart disease or disease of the ascending aorta. Traditional cardiovascular risk factors predicted surgery for aortic stenosis, but after excluding cases with coronary atherosclerosis, these associations were no longer present.
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