Key result
Male sex was associated with higher aortic valve calcification progression than female sex (median 26 vs 4 AU, P<0.001); progression was linked to dyslipidemia in men and hypertension in women.
Why the study?
Guidelines recommend measuring aortic valve calcification to differentiate aortic stenosis severity, but data about aortic valve calcification in the general population remain scarce.
Cohort (n=823)
Absolute Event Rate: 26% vs 4%
p-value: p=<0.001
Aortic valve calcification progression in the general population is primarily driven by baseline calcification burden, with distinct sex-specific risk factors including hypertension in women and dyslipidemia in men.
Sex-specific AVC risk factors may guide monitoring; leaves open whether targeting hypertension or dyslipidemia alters progression.
Background: Guidelines recommend measurement of the aortic valve calcification (AVC) score to help differentiate between severe and nonsevere aortic stenosis, but a paucity exists in data about AVC in the general population. The aim of this study was to describe the natural history of AVC progression in the general population and to identify potential sex differences in factors associated with this progression rate. Methods: Noncontrast cardiac computed tomography was performed in 1298 randomly selected women and men aged 65 to 74 years who participated in the DANCAVAS trial (Danish Cardiovascular Screening). Participants were invited to attend a reexamination after 4 years. The AVC score was measured at the computed tomography, and AVC progression (ΔAVC) was defined as the difference between AVC scores at baseline and follow-up. Multivariable regression analyses were performed to identify factors associated with ΔAVC. Results: Among the 1298 invited citizens, 823 accepted to participate in the follow-up examination. The mean age at follow-up was 73 years. Men had significantly higher AVC scores at baseline (median AVC score 13 Agatston Units [AU; interquartile range, 0–94 AU] versus 1 AU [interquartile range, 0–22 AU], P <0.001) and a higher ΔAVC (median 26 AU [interquartile range, 0–101 AU] versus 4 AU [interquartile range, 0–37 AU], P <0.001) than women. In the fully adjusted model, the most important factor associated with ΔAVC was the baseline AVC score. However, hypertension was associated with ΔAVC in women (incidence rate ratios, 1.58 [95% CI, 1.06–2.34], P =0.024) but not in men, whereas dyslipidemia was associated with ΔAVC in men (incidence rate ratio: 1.66 [95% CI, 1.18–2.34], P =0.004) but not in women. Conclusions: The magnitude of the AVC score was the most important marker of AVC progression. However, sex differences were significant; hence, dyslipidemia was associated with AVC progression only among men; hypertension with AVC progression only among women. Registration: URL: https://www.isrctn.com; Unique identifier: ISRCTN12157806.
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Diederichsen et al. (2022) conducted a cohort in Aortic valve calcification (n=823). Male sex vs. Female sex was evaluated on Aortic valve calcification progression (ΔAVC) (p=<0.001). Male sex was associated with higher aortic valve calcification progression than female sex (median 26 vs 4 AU, P<0.001); progression was linked to dyslipidemia in men and hypertension in women.
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