Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.
Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.
Eur Heart J Cardiovasc Imaging. 2020 Jul 1;21(7):718-724. doi: 10.1093/ehjci/jeaa065.
Vitamin K antagonists (VKAs) are suspected of causing aortic valve calcification (AVC). The objective of this study was to clarify whether patients undergoing VKA treatment have increased AVC scores compared to patients treated with new oral anticoagulants (NOACs) and patients who never have been treated with VKA/NOAC.
We included participants from the population-based DANCAVAS trial (n = 15 048). Information on confounders was collected, and the AVC scores were measured on non-contrast computed tomography scans. The participants' medication data, including VKA and NOAC data, were collected from the Danish National Health Service Prescription Database. The final population consisted of 14 604 participants (67.4 years, 95% men) of whom 873 had been treated with VKA and 602 with NOAC. The association between AVC score and duration of anticoagulant use was investigated in an adjusted zero-inflated negative binomial regression model. For every year treated with VKA, the AVC score increased, on average, by 6% [ratio of expected counts (RECs) = 1.06; 95% confidence interval (CI) 1.02-1.10] compared to non-use. The results were consistent in sensitivity analyses excluding patients with known cardiovascular disease and statin users (REC = 1.07; 95% CI 1.02-1.11 and REC = 1.10; 95% CI 1.03-1.17, respectively). NOAC treatment was not significantly associated with AVC score in any of the corresponding models (REC = 1.03, 1.02, and 0.96).
Compared to no treatment with anticoagulants, VKA use was associated with increased AVC score, while a similar association could not be established for NOAC.
维生素 K 拮抗剂（VKAs）被怀疑会导致主动脉瓣钙化（AVC）。本研究的目的是明确接受 VKA 治疗的患者的 AVC 评分是否高于接受新型口服抗凝剂（NOACs）治疗的患者和从未接受过 VKA/NOAC 治疗的患者。
我们纳入了来自基于人群的 DANCAVAS 试验的参与者（n=15048）。收集了混杂因素信息，并在非对比计算机断层扫描上测量了 AVC 评分。参与者的用药数据，包括 VKA 和 NOAC 数据，是从丹麦国家卫生服务处方数据库中收集的。最终的研究人群由 14604 名参与者组成（67.4 岁，95%为男性），其中 873 名接受了 VKA 治疗，602 名接受了 NOAC 治疗。在调整后的零膨胀负二项回归模型中，研究了 AVC 评分与抗凝治疗时间的关系。与未使用抗凝剂相比，每使用 VKA 治疗一年，AVC 评分平均增加 6%[预期计数比（REC）=1.06；95%置信区间（CI）1.02-1.10]。在排除已知心血管疾病患者和他汀类药物使用者的敏感性分析中，结果一致（REC=1.07；95%CI 1.02-1.11 和 REC=1.10；95%CI 1.03-1.17）。在任何相应的模型中，NOAC 治疗与 AVC 评分均无显著相关性（REC=1.03、1.02 和 0.96）。
与未使用抗凝剂相比，VKA 的使用与 AVC 评分的增加相关，而对于 NOAC，则无法建立类似的相关性。
