Disclosures: The authors report no relevant financial disclosures.
January 14, 2022
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Hypertension, dyslipidemia affect aortic valve calcium progression differently by sex

Disclosures: The authors report no relevant financial disclosures.
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Baseline aortic valve calcification was the most significant factor for calcium progression overall, but hypertension and dyslipidemia were the strongest predictors of aortic valve calcium progression among women and men, respectively.

For the study published in Circulation: Cardiovascular Imaging, researchers evaluated aortic valve calcification (AVC) in the general population of Denmark and sought to identify any potential sex-based risk factors related to calcium progression.

3D heart valves_175470830
Source: Adobe Stock

“So far, attempts have failed to identify medical treatment that may prevent or reduce the progression of stenosis. One possible explanation is that the included patients’ disease had advanced too much. Therefore, increasing attention has been given to AVC as a precursor to overt aortic stenosis,” Axel Diederichsen, MD, PhD, of the department of cardiology at Odense University Hospital, Denmark, and colleagues wrote. “It is well established that the association of AVC with aortic stenosis severity is largely affected by sex, as women may experience severe aortic stenosis at lower AVC scores than men. It is thus likely that determinants of AVC progression may differ between men and women.”

To investigate potential differences, researchers analyzed participants from the Danish Cardiovascular Screening trial aged 65 to 74 years who underwent noncontrast cardiac CT at baseline, of whom of 823 (mean age, 73 years) returned for reevaluation after 4 years.

Progression of AVCs was defined as the difference between AVC at baseline and reevaluation. Researchers identified factors associated with progression using multivariable regression analyses.

At baseline, 44% of participants had no AVC while 56% presented with some degree of calcification.

AVC progressed on average 11 Agatston units (AU) in the overall cohort.

According to the study, men had higher median AVC scores at baseline compared with women (13 AU vs. 1 AU; P < .001). Men also had greater median progression in AVC compared with women (26 AU vs. 4 AU; P < .001).

After adjusting for baseline aortic valve calcium score, sex, age, smoking, hypertension, dyslipidemia, diabetes, prior CVD, BMI and baseline coronary artery calcium score, researchers reported that only baseline aortic valve calcium and male sex remained associated with calcium progression (P < .05).

In a similarly adjusted multivariable model, hypertension was the sole predictor of aortic valve calcium progression among women (incidence rate ratio [IRR] = 1.58; 95% CI, 1.06-2.34; P = .024) and dyslipidemia was the sole predictor among men (IRR = 1.66; 95% CI, 1.18-2.33; P = .004).

“The magnitude of the AVC score is the most important risk marker for AVC progression, whereas the traditional risk markers were of minor or no importance,” the researchers wrote. “However, sex differences were significant; hence, dyslipidemia was associated with AVC progression only among men; hypertension with AVC progression only among women. These findings may have implications in trials testing new therapies to prevent AVC progression in women as well as men.”