Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany.
Biometry, and Epidemiology, Institute of Medical Informatics, University Duisburg-Essen, Essen, Germany.
Heart. 2014 Jun;100(12):930-7. doi: 10.1136/heartjnl-2013-305205. Epub 2014 Feb 5.
Aortic valve calcification (AVC) is considered a manifestation of atherosclerosis. In this study, we investigated whether AVC adds to cardiovascular risk prediction beyond Framingham risk factors and coronary artery calcification (CAC).
A total of 3944 subjects from the population based Heinz Nixdorf Recall Study (59.3±7.7 years; 53% females) were evaluated for coronary events, stroke, and cardiovascular disease (CVD) events (including all plus CV death) over 9.1±1.9 years. CT scans were performed to quantify AVC. Cox proportional hazards regressions and Harrell's C were used to examine AVC as event predictor in addition to risk factors and CAC.
During follow-up, 138 (3.5%) subjects experienced coronary events, 101 (2.6%) had a stroke, and 257 (6.5%) experienced CVD events. In subjects with AVC>0 versus AVC=0 the incidence of coronary events was 8.0% versus 3.0% (p<0.001) and the incidence of CVD events was 13.0% versus 5.7% (p<0.001). The frequency of events increased significantly with increasing AVC scores (p<0.001). After adjustment for Framingham risk factors, high AVC scores (3rd tertile) remained independently associated with coronary events (HR 2.21, 95% CI 1.28 to 3.81) and CVD events (HR 1.67, 95% CI 1.08 to 2.58). After further adjustment for CAC score, HRs were attenuated (coronary events 1.55, 95% CI 0.89 to 2.69; CVD events 1.29, 95% CI 0.83 to 2.00). When adding AVC to the model containing traditional risk factors and CAC, Harrell's C indices did not increase for coronary events (from 0.744 to 0.744) or CVD events (from 0.759 to 0.759).
AVC is associated with incident coronary and CVD events independent of Framingham risk factors. However, AVC fails to improve cardiovascular event prediction over Framingham risk factors and CAC.
主动脉瓣钙化（AVC）被认为是动脉粥样硬化的一种表现。在这项研究中，我们研究了 AVC 是否可以在 Framingham 风险因素和冠状动脉钙化（CAC）之外增加心血管风险预测。
共有 3944 名来自基于人群的 Heinz Nixdorf 召回研究的受试者（59.3±7.7 岁；53%为女性），在 9.1±1.9 年内评估了冠状动脉事件、中风和心血管疾病（CVD）事件（包括所有 CV 死亡）。进行 CT 扫描以量化 AVC。使用 Cox 比例风险回归和 Harrell's C 来检查 AVC 作为事件预测因子，以及风险因素和 CAC。
在随访期间，138 名（3.5%）受试者发生了冠状动脉事件，101 名（2.6%）发生了中风，257 名（6.5%）发生了 CVD 事件。在 AVC>0 与 AVC=0 的受试者中，冠状动脉事件的发生率分别为 8.0%和 3.0%（p<0.001），CVD 事件的发生率分别为 13.0%和 5.7%（p<0.001）。随着 AVC 评分的增加，事件的频率显著增加（p<0.001）。在调整了 Framingham 风险因素后，高 AVC 评分（第三 tertile）与冠状动脉事件（HR 2.21，95%CI 1.28 至 3.81）和 CVD 事件（HR 1.67，95%CI 1.08 至 2.58）仍独立相关。在进一步调整 CAC 评分后，HR 减弱（冠状动脉事件 1.55，95%CI 0.89 至 2.69；CVD 事件 1.29，95%CI 0.83 至 2.00）。当将 AVC 添加到包含传统风险因素和 CAC 的模型中时，冠状动脉事件（从 0.744 增加到 0.744）或 CVD 事件（从 0.759 增加到 0.759）的 Harrell's C 指数没有增加。
AVC 与Framingham 风险因素无关，与冠状动脉和 CVD 事件的发生相关。然而，AVC 并不能提高Framingham 风险因素和 CAC 对心血管事件的预测。
