Key result
Hypertension, diabetes, and dyslipidemia are linked to up to ~71% higher severe aortic stenosis risk.
Why the study?
Few longitudinal studies have delineated the association between traditional cardiovascular risk factors and the development of aortic stenosis.
Cohort (n=1,120,000)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“While this large population-based observational study alone cannot establish causality, it adds to the existing evidence that modifiable cardiovascular risk factors play an important and causative role in aortic stenosis. Beyond other proven benefits in atherosclerotic diseases, optimal risk factor management may also mitigate the burden of aortic stenosis in the aging population.”
Observational cohort study finds hypertension, diabetes, and dyslipidemia heighten severe aortic stenosis risk in older adults, indicating potential targets to prevent advanced valve disease.
BACKGROUND: Few longitudinal studies have delineated the association between traditional cardiovascular risk factors and development of aortic stenosis (AS). OBJECTIVES: The authors examined the association between traditional cardiovascular risk factors and incident severe AS in a large, unselected elderly population. METHODS: This observational cohort study used multiple linked health care population-based databases of individuals older than 65 years on April 1, 2002, without prior valvular disease, coronary artery disease, heart failure, cardiac arrhythmia, cerebrovascular disease, congenital heart disease, or admissions with cardiac symptoms. The relationship between hypertension (HTN), diabetes, dyslipidemia, and incident severe AS requiring hospitalization or surgical or interventional treatment was examined. RESULTS: Among 1.12 million individuals followed for a median of 13 years, 20,995 subjects developed severe AS. Overall absolute incidence was 144 per 100,000 person-years (169 and 127 per 100,000 person-years in men and women, respectively). In cause-specific hazard models, HTN (adjusted hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.66 to 1.76), diabetes (HR: 1.49; 95% CI: 1.44 to 1.54), and dyslipidemia (HR: 1.17; 95% CI: 1.14 to 1.21) were all significantly associated with increased risk of developing severe AS (all p < 0.001). There was a positive dose-response relationship between the number and duration of cardiac risk factors and risk of AS. In the Fine-Gray model, all 3 risk factors were independently associated with a higher incidence of AS. The population-attributable risk of AS associated with 3 cardiac risk factors was 34.4% (95% CI: 32.8 to 36.0). CONCLUSIONS: HTN, diabetes, and dyslipidemia have independent and dose-response associations with incident AS in an unselected population of older individuals, and together accounted for approximately one-third of the incidence of severe AS.
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Yan et al. (2017) conducted a cohort in Aortic stenosis (n=1,120,000). Hypertension, diabetes, and dyslipidemia vs. Absence of risk factors was evaluated on Incident severe aortic stenosis requiring hospitalization or surgical or interventional treatment (HR 1.71, 95% CI 1.66-1.76, p=< 0.001). Hypertension (HR 1.71), diabetes (HR 1.49), and dyslipidemia (HR 1.17) were independently associated with an increased risk of incident severe aortic stenosis (all P<0.001).
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