University of Washington, Seattle, Washington, USA.
Am J Cardiol. 2010 Mar 1;105(5):701-8. doi: 10.1016/j.amjcard.2009.10.071.
Aortic valve calcium (AVC) is common among older adults and shares epidemiologic and histopathologic similarities to atherosclerosis. However, prospective studies have failed to identify meaningful risk associations with incident ("new") AVC or its progression. In the present study, AVC was quantified from serial computed tomographic images from 5,880 participants (aged 45 to 84 years) in the Multi-Ethnic Study of Atherosclerosis, using the Agatston method. Multivariate backward selection modeling was used to identify the risk factors for incident AVC and AVC progression. During a mean follow-up of 2.4 +/- 0.9 years, 210 subjects (4.1%) developed incident AVC. The incidence rate (mean 1.7%/year) increased significantly with age (p <0.001). The risk factors for incident AVC included age, male gender, body mass index, current smoking, and the use of lipid-lowering and antihypertensive medications. Among those with AVC at baseline, the median rate of AVC progression was 2 Agatston units/year (interquartile range -21 to 37). The baseline Agatston score was a strong, independent predictor of progression, especially among those with high calcium scores at baseline. In conclusion, in this ethnically diverse, preclinical cohort, the rate of incident AVC increased significantly with age. The incident AVC risk was associated with several traditional cardiovascular risk factors, specifically age, male gender, body mass index, current smoking, and the use of both antihypertensive and lipid-lowering medications. AVC progression risk was associated with male gender and the baseline Agatston score. Additional research is needed to determine whether age- and stage-specific mechanisms underlie the risk of AVC progression.
主动脉瓣钙化（AVC）在老年人中很常见，其在流行病学和组织病理学方面与动脉粥样硬化有相似之处。然而，前瞻性研究未能确定与新发 AVC 或其进展相关的有意义的风险关联。在本研究中，使用 Agatston 方法，从动脉粥样硬化多民族研究中的 5880 名参与者（年龄在 45 岁至 84 岁之间）的连续计算机断层扫描图像中定量评估 AVC。使用多元向后选择建模来确定新发 AVC 和 AVC 进展的危险因素。在平均 2.4±0.9 年的随访期间，有 210 名受试者（4.1%）发生新发 AVC。发病率（平均每年 1.7%）随年龄显著增加（p<0.001）。新发 AVC 的危险因素包括年龄、男性、体重指数、当前吸烟以及使用降脂和降压药物。在基线时患有 AVC 的患者中，AVC 进展的中位数率为 2 个 Agatston 单位/年（四分位距为-21 至 37）。基线 Agatston 评分是进展的强有力独立预测因素，尤其是在基线时钙评分较高的患者中。总之，在这个种族多样化的临床前队列中，新发 AVC 的发生率随年龄显著增加。新发 AVC 的风险与几种传统心血管危险因素相关，特别是年龄、男性、体重指数、当前吸烟以及使用降压和降脂药物。AVC 进展的风险与性别和基线 Agatston 评分相关。需要进一步研究以确定年龄和阶段特异性机制是否是 AVC 进展风险的基础。
