European Heart Journal Advance Access originally published online on July 16, 2009
European Heart Journal 2009 30(16):2044-2053; doi:10.1093/eurheartj/ehp287
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Association between degenerative aortic valve disease and long-term exposure to cardiovascular risk factors: results of the longitudinal population-based KORA/MONICA survey
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1 Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
2 Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
3 Department of Internal Medicine II, University of Regensburg, Regensburg, Germany
4 Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
5 Department of Internal Medicine II, University of Ulm, Ulm, Germany
6 Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
7 Institute of Human Genetics, University of Lübeck, Lübeck, Germany
Received 11 February 2009; revised 18 May 2009; accepted 22 June 2009; online publish-ahead-of-print 16 July 2009.
* Corresponding author. Tel: +49 451 500 2501, Fax: +49 451 500 6437, Email: heribert.schunkert{at}uk-sh.de
See page 1940 for the editorial comment on this article (doi:10.1093/eurheartj/ehp175)
Aims: Degenerative aortic valve disease (DAVD), a common finding in the elderly, is associated with an increased risk of death due to cardiovascular causes. Taking advantage of its longitudinal design, this study evaluates the prevalence of DAVD and its temporal associations with long-term exposure to cardiovascular risk factors in the general population.
Methods and results: We studied 953 subjects (aged 25–74 years) from a random sample of German residents. Risk factors had been determined at a baseline investigation in 1994/95. At a follow-up investigation, 10 years later, standardized echocardiography determined aortic valve morphology and aortic valve area (AVA) as well as left ventricular geometry and function. At the follow-up study, the overall prevalence of DAVD was 28%. In logistic regression models adjusting for traditional cardiovascular risk factors at baseline age (OR 2.0 [1.7–2.3] per 10 years, P < 0.001), active smoking (OR 1.7 [1.1–2.4], P = 0.009) and elevated total cholesterol levels (OR 1.2 [1.1–1.3] per increase of 20 mg/dL, P < 0.001) were significantly related to DAVD at follow-up. Furthermore, age, baseline status of smoking, and total cholesterol level were significant predictors of a smaller AVA at follow-up study. In contrast, hypertension and obesity had no detectable relationship with long-term changes of aortic valve structure.
Conclusions: In the general population we observed a high prevalence of DAVD that is associated with long-term exposure to elevated cholesterol levels and active smoking. These findings strengthen the notion that smoking cessation and cholesterol lowering are promising treatment targets for prevention of DAVD.
Key Words: Epidemiology • Degenerative aortic valve disease • Risk factor • Cholesterol • Smoking
The MONICA Augsburg study was initiated by U. Keil and co-workers. The KORA Group consists of H.E. Wichmann (speaker), H. Löwel, C. Meisinger, T.Illig, R. Holle, J. John and their co-workers who are responsible for the design and conduct of the KORA studies.
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  C. M. Otto Calcific aortic valve disease: outflow obstruction is the end stage of a systemic disease process Eur. Heart J., August 2, 2009; 30(16): 1940 - 1942. [Full Text] [PDF]
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