Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly

Background Although aortic-valve stenosis is clearly associated with advers e cardiovascular outcomes, it is unclear whether valve sclerosis increases the risk of cardiovascular events. Methods We assessed echocardiograms obtained at base line from 5621 men and women 65 years of age or older who were enrolled in a population-based pro spective study, On echocardiography, the aortic valve was normal in 70 perc ent (3919 subjects), sclerotic without outflow obstruction in 29 percent (1 610), and stenotic in 2 percent (92), The subjects were followed for a mean of 5.0 years to assess the risk of death from any cause and of death from cardiovascular causes. Cardiovascular morbidity was defined as new episodes of myocardial infarction, angina pectoris, congestive heart failure, or st roke. Results There was a stepwise increase in deaths from any cause (P for trend , <0.001) and deaths from cardiovascular causes (P for trend, <0.001) with increasing aortic-valve abnormality; the respective rates were 14.9 and 6.1 percent in the group with normal aortic valves, 21.9 and 10.1 percent in t he group with aortic sclerosis, and 41.3 and 19.6 percent in the group with aortic stenosis, The relative risk of death from cardiovascular causes amo ng subjects without coronary heart disease at base line was 1.66 (95 percen t confidence interval, 1.23 to 2.23) for those with sclerotic valves as com pared with those with normal valves, after adjustment for age and sex. The relative risk remained elevated after further adjustment for clinical facto rs associated with sclerosis (relative risk, 1.52; 95 percent confidence in terval, 1.12 to 2.05), The relative risk of myocardial infarction was 1.40 (95 percent confidence interval, 1.07 to 1.83) among subjects with aortic s clerosis, as compared with those with normal aortic valves. Conclusions Aortic sclerosis is common in the elderly and is associated wit h an increase of approximately 50 percent in the risk of death from cardiov ascular causes and the risk of myocardial infarction, even in the absence o f hemodynamically significant obstruction of left ventricular outflow. (N E ngl J Med 1999;341:142-7) (C) 1999, Massachusetts Medical Society.