Abstract
Objectives. Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age. Design. This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking. Results. In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45–7.93] and 1.60 [1.09–2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19–8.76]). Conclusion. Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.
Highlights
In western countries, aortic valve replacement is the second most common cardiothoracic procedure, following coronary artery by-pass surgery [1]
We prospectively studied the presence of traditional cardiovascular risk factors prior to surgery for aortic stenosis among patients without coronary artery disease (CAD) and stratified for age (
Of the 322 patients operated for the primary indication of aortic stenosis, 70 underwent surgery before 60 years of age and 252 after 60 years of age
Summary
Aortic valve replacement is the second most common cardiothoracic procedure, following coronary artery by-pass surgery [1]. Among patients with aortic stenosis over 60 years old, tricuspid valves are most prevalent, comorbidity with coronary atherosclerosis is common [2], and traditional cardiovascular risk factors play an important role [3]. In patients under 60 years old, bicuspid aortic valve (BAV) is the most common underlying valve pathology, and little information is available regarding the influence of traditional cardiovascular risk factors on aortic stenosis development in this population. Several possible risk factors, such as hypercholesterolemia, have emerged in this context. Treatment targeting these risk factors has not been shown to modify the course of disease progression [4,5,6]
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