Cardiovascular Risk Factors in Patients with Valvular Heart Disease: A Nationwide Observational Cohort Study

Purpose: Conventional cardiovascular risk factors may contribute to the development of valvular heart disease (VHD). The present study sought to investigate the distribution of conventional modifiable cardiovascular risk factors (smoking, hypertension, hyperlipidemia, and diabetes) in various VHDs, the impact of risk factors on outcomes, and the prognostic indicators in patients with distinct burdens of risk factors. Patients and methods: The study included 11862 patients with moderate or greater VHD. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure, and myocardial infarction within two years. Results: Of 11862 patients with VHD, the mean age was 61.77 ± 13.51 years, and 44.4% were female. The prevalences of smoking, hypertension, hyperlipidemia, and diabetes were 14.9%, 45.0%, 13.4%, and 14.5% in the total cohort. Patients with zero, one, two, three, or four risk factors accounted for 39.4%, 38.2%, 17.7%, 4.3%, and 0.3%, respectively. The number of conventional risk factors was independently associated with two-year outcome in patients with mitral regurgitation (MR; three/four vs zero: hazard ratio [HR, 95% confidence interval (CI)]: 1.600 [1.106-2.315], P = 0.013; two vs zero: HR [95% CI]: 1.153 [0.867-1.532], P = 0.328; one vs zero: HR [95% CI]: 0.892 [0.687-1.159], P = 0.393). Stratified by the etiology of mitral valve lesions, each one risk factor increase was independently related to a 17.3% higher risk of adverse events in secondary MR. In patients with three or four risk factors, females had a significantly poorer outcome than males (P = 0.002). Conclusion: More than one of five VHD patients had at least two conventional cardiovascular risk factors. The increasing number of risk factors indicated poor prognosis in patients with significant MR. Optimizing risk factor control may improve secondary prevention as well as long-term outcomes of VHD.