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Previous Volume 341:142-147 July 15, 1999 Number 3 Next

	Full Text PDF Editorial by Carabello, B. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Although aortic-valve stenosis is clearly associated with adverse cardiovascular outcomes, it is unclear whether valve sclerosis increases the risk of cardiovascular events.

Methods We assessed echocardiograms obtained at base line from 5621 men and women 65 years of age or older who were enrolled in a population-based prospective study. On echocardiography, the aortic valve was normal in 70 percent (3919 subjects), sclerotic without outflow obstruction in 29 percent (1610), and stenotic in 2 percent (92). The subjects were followed for a mean of 5.0 years to assess the risk of death from any cause and of death from cardiovascular causes. Cardiovascular morbidity was defined as new episodes of myocardial infarction, angina pectoris, congestive heart failure, or stroke.

Results There was a stepwise increase in deaths from any cause (P for trend, <0.001) and deaths from cardiovascular causes (P for trend, <0.001) with increasing aortic-valve abnormality; the respective rates were 14.9 and 6.1 percent in the group with normal aortic valves, 21.9 and 10.1 percent in the group with aortic sclerosis, and 41.3 and 19.6 percent in the group with aortic stenosis. The relative risk of death from cardiovascular causes among subjects without coronary heart disease at base line was 1.66 (95 percent confidence interval, 1.23 to 2.23) for those with sclerotic valves as compared with those with normal valves, after adjustment for age and sex. The relative risk remained elevated after further adjustment for clinical factors associated with sclerosis (relative risk, 1.52; 95 percent confidence interval, 1.12 to 2.05). The relative risk of myocardial infarction was 1.40 (95 percent confidence interval, 1.07 to 1.83) among subjects with aortic sclerosis, as compared with those with normal aortic valves.

Conclusions Aortic sclerosis is common in the elderly and is associated with an increase of approximately 50 percent in the risk of death from cardiovascular causes and the risk of myocardial infarction, even in the absence of hemodynamically significant obstruction of left ventricular outflow.

Source Information

From the Departments of Medicine (C.M.O., D.S.S.), Biostatistics (B.K.L.), and Epidemiology (D.S.S.) and the Cardiovascular Health Research Unit (D.S.S.), University of Washington, Seattle; the Division of Cardiology, Wake Forest University School of Medicine, Winston-Salem, N.C. (D.W.K.); and the Division of Cardiology, Mayo Clinic, Rochester, Minn. (B.J.G.).

Address reprint requests to Dr. Otto at the Division of Cardiology, Box 356422, University of Washington, Seattle, WA 98195-6422.

Full Text of this Article

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Aortic-Valve Sclerosis
Getchell W. S., Kim D. K., Rajput V., Achuff S. C., Baumgartner W. A., Otto C. M., Siscovick D. S.
Extract | Full Text  
N Engl J Med 1999; 341:1856-1857, Dec 9, 1999. Correspondence

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