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Calcific aortic valve disease: outflow obstruction is the end stage of a systemic disease process

Catherine M. Otto
DOI: http://dx.doi.org/10.1093/eurheartj/ehp175 1940-1942 First published online: 16 July 2009

Over the past decade, a body of evidence has accumulated demonstrating that calcific aortic valve disease (CAVD) is prevalent in older adults and that the presence of calcific valve disease is associated with adverse clinical outcomes, even in the absence of left ventricular (LV) outflow tract obstruction. Stritzke et al. report for the KORA/MONICA study that degenerative (or calcific) aortic valve disease was present in 28% of a population-based sample of >900 adults with a mean age of ∼50 years.1 This finding parallels previous population-based studies such as the Helsinki Aging Study2 with a prevalence of aortic sclerosis of 21% in adults aged 55–71 years and the Cardiovascular Health Study (CHS) with aortic sclerosis in 26% of adults age 65 years or older.3

Further, in the KORA/MONICA study, the presence of calcific valve disease was associated with age, active smoking, and elevated total cholesterol on a baseline evaluation carried out 10 years before the echocardiographic study.1 These findings support the concept that patients ‘at risk’ of CAVD can be identified based on these associated clinical factors. In addition to age, smoking, and hypercholesterolaemia, previous studies have convincingly shown that the presence of calcific valve disease is associated with hypertension, diabetes, and the metabolic syndrome.3,4 Recent data from the Multi-Ethnic Study of Atherosclerosis (MESA) study indicated that the total cholesterol to HDL ratio is associated with an increased risk of CAVD across the entire age range (45–84 years), whereas LDL is associated with increased risk only in those <65 years of age.5

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*Corresponding author. Tel: +1 206 685 1379, Fax: +1 206 616 4847, Email: cmotto{at}u.washington.edu