Aortic sclerosis risk factors

Overview
Aortic sclerosis is non-obstructive degeneration of the aortic valve that presents predominantly in patients over 65 years of age who have risk factors for coronary artery disease. Because aortic sclerosis is associated with coronary artery disease risk factors, it is also associated with a significant increase in the risk of cardiovascular death, myocardial infarction even in the absence of hemodynamically significant left ventricular outflow tract obstruction. However, it remains unclear whether aortic sclerosis is independently associated with risk or merely a marker of coexistent cardiovascular risk factors.

Risk Factors for Aortic Sclerosis

 * Independent clinical factors that is associated with increased incidence of aortic sclerosis include:
 * Age (twofold increased risk for each 10-year increase in age)
 * Male gender (twofold excess risk)
 * Present smoking (35% increase in risk)
 * History of hypertension (20% increase in risk) with subsequent left ventricular hypertrophy
 * Height
 * Elevated lipoprotein(a) and elevated low density lipoprotein cholesterol levels
 * End-stage renal disease on maintenance dialysis.
 * Metabolic syndrome and diabetes mellitus


 * The MESA study quantified aortic valve calcification by serial computed tomographic images from 5,880 participants aged 45 to 84 years reported an 1.7% per year incidence rate of aortic valve calcification which increased significantly with age.

Aortic Sclerosis as a Risk Factor for Coronary Artery Disease

 * In addition to the presence of traditional risk factors for coronary artery disease such as hypertension, diabetes, hyperlipidemia  and smoking, the presence of multiple calcium deposits in the mitral annulus, aortic valve or aortic root have been shown to be a predictor of coronary artery disease among elderly patients with aortic sclerosis.


 * The Heart and Soul study evaluated 814 outpatients with established coronary heart disease and no evidence of aortic stenosis, to examine the association of aortic sclerosis with subsequent cardiovascular events. At baseline, 40% of the enrolled subjects had aortic sclerosis. During 4-year follow-up, a significant number of patients with aortic sclerosis experienced myocardial infarction in comparison to patients without aortic sclerosis: 10% versus 5% (HR 1.8; 95%CI,1.1-3.1; P=0.02). Additionally, the association between aortic sclerosis and MI appeared to differ by statin use (P=0.15 for interaction). Thus, the study concluded aortic sclerosis was independently associated with a 2.4-fold increased rate of subsequent MI. Furthermore, administration of statins attenuated the risk of future MI in patients with aortic sclerosis.