Prognostic Significance of Aortic Valve Calcification in Relation to Coronary Artery Calcification for Cardiovascular Diseases.

Abstract

Both coronary artery calcification (CAC) and aortic valve calcification (AVC) are strongly associated with cardiovascular diseases (CVD), but data about the prognostic significance of multiple cardiovascular calcifications are limited. We aim to investigate the interaction relationship of AVC and CAC for major events. We included 6,695 participants from the Multi-Ethnic Study of Atherosclerosis at baseline, and divided them into four groups: 1) no AVC or CAC; 2) only AVC; 3) only CAC; 4) with CAC and CAC. Cox regression model and Kaplan-Meier method were used to analyze CVD outcomes. We evaluated the interaction between AVC and CAC, and their added predictive value based on the pooled cohort equations (PCEs). The subgroup analyses were also explored. Among 6,695 participants (mean age 62.2 ± 10.2 years, 47.2% male), after follow-up, 943 cases (14.1%) of CVD and 1274 cases (19.0%) of all-cause death occurred. For participants with both AVC and CAC, the risk of CVD significantly increased {HR =3.43 (2.69-4.37), P <0.001}, even higher than the sum of the ones with only AVC and only CAC. This trend remained the same for all-cause death and among subgroup analysis. The addictive interaction was statistically significant (P <0.001). When added AVC and CAC, the predictive value of PCEs increased. Our results indicated a synergistical interaction between valve calcification and coronary calcification to cardiovascular diseases. Management for both AVC and CAC may bring health co-benefits in preventing poor outcomes.