Key result
Female sex linked to ~52% less aortic valve calcification and reduced coronary calcium in aortic stenosis.
Why the study?
Significant sex differences exist in the prevalence and severity of cardiac calcification, with women having more severe mitral annular calcification and men worse aortic valve and coronary calcification, but underlying correlates according to sex remain unclear.
Do the correlates of valvular and arterial calcification burden differ between men and women with ≥mild aortic stenosis?
Cross-Sectional (n=406)
Do the correlates of valvular and arterial calcification burden differ between men and women with ≥mild aortic stenosis?
Absolute Event Rate: 480% vs 1003%
p-value: p=<0.0001
Sex is an independent predictor of cardiac calcification subtypes in patients with aortic stenosis, with distinct clinical correlates for calcification burden in men versus women.
May inform sex-specific calcification assessment in aortic stenosis; leaves open effects on progression and outcomes.
Introduction There are significant sex differences in the prevalence and severity of cardiac calcifying processes. Women harbour more severe mitral annular calcification (MAC), while men exhibit worse aortic valve (AVC) and coronary artery (CAC) calcification. To better understand these differences, we investigated the correlates of cardiac calcification according to sex. Methods We conducted a cross-sectional study of 406 patients with ≥mild aortic stenosis (AS) defined by an aortic valve area ≤1.5 cm 2 , a peak aortic jet velocity >2.0 m/s, or a mean transvalvular gradient >15 mm Hg. Doppler-echocardiography and non-contrast multidetector CT were performed concomitantly to assess AS and cardiac calcifications. Results Mean age was 71±11 years and 33% were women. The AS haemodynamics were not significantly different between sexes (all p>0.50), with a mean indexed aortic valve area of 0.59±0.21 cm 2 /m 2 , peak aortic jet velocity of 2.78 (2.37–3.68) m/s, and mean gradient of 17.9 (12.8–31.3) mm Hg for the whole cohort. Compared with men, women harboured lower AVC (480 (222–1191) vs 1003 (484–2329) Agatston unit, AU; p<0.0001) and CAC (366 (50–914) vs 618 (167–1357) AU; p=0.007), but more severe MAC (60 (1–887) vs 48 (0–351) AU; p=0.08) and ascending aorta calcification (227 (43–863) vs 142 (7–493) AU; p=0.03). After comprehensive adjustment, sex remained an independent predictor of each cardiac calcification subtype (all p<0.02) except for the ascending aorta (p=0.32). In multivariable analysis, certain variables, like age or bicuspid aortic valve, were associated with the calcification scores in both sexes. Sex-specific predictors of calcification burden were absence of angiotensin receptor blockers (β=−0.26; p=0.007) and renal impairment (β=0.26; p=0.003) for AVC, and bisphosphonates (β=0.20; p=0.05) for CAC in women; coronary artery disease (β=0.25; p=0.001) for AVC, and angiotensin receptor blockers (β=0.19; p=0.02) and calcium/vitamin D (β=0.15; p=0.02) for MAC in men. Conclusion In AS, factors associated with cardiac valvular and arterial calcification differ between sexes, suggesting an important contributory role of sex in the pathophysiology of these calcifying processes.
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Deslandes et al. (2022) conducted a cross-sectional in aortic stenosis (n=406). Female sex vs. Male sex was evaluated on Aortic valve calcification (AVC) in Agatston units (p=<0.0001). Female sex was associated with lower aortic valve (480 vs 1003 AU; p<0.0001) and coronary artery calcification (366 vs 618 AU; p=0.007) compared with male sex in patients with aortic stenosis.
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