Comparison of Frequency of New Coronary Events in
Older Subjects With and Without Valvular
Aortic Sclerosis
Wilbert S. Aronow,
MD
, Chul Ahn,
PhD
, Jamshid Shirani,
MD
, and Itzhak Kronzon,
MD
O
lder subjects with valvular aortic stenosis have a
higher prevalence of coronary risk factors,
1–4
a
higher prevalence of coronary artery disease
(CAD),
3,5,6
and a higher incidence of new coronary
events
6–8
than older subjects without valvular aortic
stenosis. The early lesion of degenerative valvular
aortic stenosis also has some similarities to atheroscle-
rosis.
9
In a prospective study of 2,358 older subjects
who had undergone continuous-wave Doppler echo-
cardiography, 378 (16%) had valvular aortic stenosis,
981 (42%) had valvular aortic sclerosis, and 999
(42%) had no valvular aortic stenosis or sclerosis. We
compare the frequency of new coronary events in
these older subjects with valvular aortic sclerosis and
with no valvular aortic stenosis or sclerosis.
•••
In a prospective study of 2,358 older subjects,
valvular aortic stenosis was diagnosed by 2-dimen-
sional and continuous-wave Doppler echocardiograms
in 378 subjects (16%) as previously described.
6
These
subjects with valvular aortic stenosis were excluded
from the present study. The remaining 1,980 subjects
included 625 men and 1,355 women (mean age 81 Ϯ
8 years, range 60 to 103). Of these 1,980 subjects, 981
(50%) had valvular aortic sclerosis. Valvular aortic
sclerosis was diagnosed if there was thickening of, or
calcific deposits on, the aortic valve cusps, with a peak
flow velocity across the aortic valve Յ1.5 m/s.
6
Follow-up was from the time the Doppler echocar-
diograms were obtained until the time of new coro-
nary events, death, or the cutoff date for analysis of
data. Mean follow-up was 46 Ϯ 28 months (range 2 to
157).
Prior CAD was diagnosed if the person had a
documented clinical history of myocardial infarction
or electrocardiographic evidence of Q-wave myocar-
dial infarction (n ϭ 811) or typical angina pectoris
without previous myocardial infarction (n ϭ19). New
coronary events were diagnosed if the person devel-
oped nonfatal or fatal myocardial infarction or sudden
cardiac death. Myocardial infarction was diagnosed as
previously described.
10
Sudden cardiac death was di-
agnosed as an unexpected cardiac death in a patient
with heart disease found dead within 1 hour of being
clinically stable.
11
Patients with primary ventricular
fibrillation documented by electrocardiogram were
classified as having sudden cardiac death. All coro-
nary events were reviewed with the patient’s physi-
cian by the senior investigator.
Chi-square analysis was used to examine if there
were significant differences in dichotomous variables
among subjects with and without valvular aortic scle-
rosis. Student’s t tests were used to determine if there
were significant differences in continuous variables
among subjects with and without valvular aortic scle-
rosis. Cox regression analysis was used to examine the
association between risk factors and the time to de-
velopment of a new coronary event.
Table I lists baseline data, incidence of new coro-
nary events in older subjects with and without valvular
aortic sclerosis, and levels of statistical significance.
Table II shows the Cox regression analysis for the
development of new coronary events. Prior CAD (p ϭ
0.0001), male gender (p ϭ 0.002), and valvular aortic
sclerosis (p ϭ 0.0001) were significantly associated
with the development of new coronary events. Valvu-
lar aortic sclerosis was not a predisposing factor for
bacterial endocarditis in this study.
•••
In the present study, older subjects with valvular
aortic sclerosis had a higher prevalence of prior CAD
and a higher incidence of new coronary events than
older subjects without valvular aortic sclerosis. We
previously reported that new coronary events devel-
oped in 103 of 165 older subjects (62%) with mild
valvular aortic stenosis, in 77 of 96 older subjects
(80%) with moderate valvular aortic stenosis, and in
37 of 40 older subjects (93%) with severe valvular
aortic stenosis.
6
Older subjects with mild, moderate,
and severe valvular aortic stenosis had a significantly
higher incidence of new coronary events than older
subjects with valvular aortic sclerosis in the present
From the Hebrew Hospital Home, Bronx, New York; the Department of
Geriatrics and Adult Development, Mount Sinai School of Medicine,
New York, New York; the Division of Clinical Epidemiology, Univer-
sity of Texas Medical School at Houston, Houston, Texas; the Depart-
ment of Medicine, Albert Einstein College of Medicine, Bronx, New
York; and the Department of Medicine, New York University School of
Medicine, New York, New York. Dr. Aronow’s address is: Hebrew
Hospital Home, 801 Co-op City Boulevard, Bronx, New York
10475. Manuscript received July 29, 1998; revised manuscript re-
ceived and accepted September 1, 1998.
TABLE I Baseline Data and Incidence of New Coronary
Events in Older Subjects With and Without Valvular Aortic
Sclerosis
Aortic
Sclerosis
(n ϭ 981)
No Aortic
Sclerosis
(n ϭ 999)
Men 309 (31%) 316 (32%)
Women 672 (69%) 683 (68%)
Prior CAD 488 (50%) 342 (34%)*
New coronary events 524 (53%) 306 (31%)*
Age (yr) 82 Ϯ 880Ϯ 9
†
Follow-up (mo) 43 Ϯ 27 50 Ϯ 29
†
*p Ͻ0.0001;
†
p ϭ 0.0001.
599
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