Cardiovascular Risk Factors for Aortic Stenosis

Study Questions:

What is the relationship between cardiovascular risk factors and incident severe aortic stenosis (AS)?

Methods:

The CANHEART Aortic Stenosis Study is an observational study that used multiple databases of patients ages >65 years without prior valve disease, coronary artery disease, heart failure, or other cardiac comorbidities, and examined the relationship between hypertension, diabetes, hyperlipidemia, and the development of severe AS requiring hospitalization or valve intervention.

Results:

From a cohort of 1.1 million individuals with a median follow-up of 13 years, 20,995 patients developed severe AS (144 per 100,000 person-years). On multivariable models, hypertension (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.66-1.76), diabetes (HR, 1.49; 95% CI, 1.44-1.54), and hyperlipidemia (HR, 1.17; 95% CI, 1.14-1.21) were each associated with increased risk of incident severe AS (p < 0.001 for each). A similar pattern was observed in both men and women. Each of these factors had a positive dose-response relationship between the risk factor and incidence of severe AS. These three risk factors had a population-attributable risk of 34.4% for severe AS, with the largest risk associated with hypertension (23.4%), and lower risks associated with diabetes (5.6%) and hyperlipidemia (4.4%).

Conclusions:

The authors concluded that hypertension, hyperlipidemia, and diabetes are each associated with risk of incident severe AS, and may account for 34% of individuals with severe AS.

Perspective:

This large observational study finds that hypertension, hyperlipidemia, and diabetes are associated with risk of hospitalization or intervention for severe AS. Other cardiovascular risk factors including tobacco use and obesity could not be completely evaluated in this study. These data also suggest that hypertension, hyperlipidemia, and diabetes may account for about one in three cases of severe AS, with the bulk of these cases potentially attributable to hypertension. It remains unclear whether treatment of these risk factors attenuates risk. Prior randomized trials have failed to show a benefit for patients with AS treated with statins, and there is a lack of randomized trials evaluating whether optimal treatment of hypertension or diabetes reduces incident severe AS. While the findings of this study suggest that patients with these comorbidities may be at increased risk of severe AS, it is unclear whether treating these risk factors alters outcomes. This will have to be evaluated in future studies.


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