Sex-Specific Prognostic Value of Aortic Valve Calcium and the Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND

In general, women have lower aortic valve calcium (AVC) scores compared with men of similar age, and the AVC score threshold for diagnosing severe aortic stenosis (AS) is lower for women. We examined whether the association of AVC with the long-term risk of clinically significant AS differed for women compared with men.

METHODS

AVC was measured using cardiac computed tomography among 6810 MESA (Multi-Ethnic Study of Atherosclerosis) participants. We examined AVC as a continuous (ln [AVC+1]) and categorical variable (0, 1-99, 100-299, ≥300 AU). Incident moderate or severe AS was adjudicated using standard clinical criteria with a median follow-up of 16 years. The association between AVC and AS was examined using multivariable-adjusted Cox proportional hazards regression.

RESULTS

Women comprised 52.9% of participants, with AVC >0 present among 10.1% of women and 17.0% of men. There were 65 cases of incident AS in women and 75 in men. AVC as a continuous variable was associated with a higher risk of incident AS for women (hazard ratio, 1.91 [95% CI, 1.68-2.16]) and men (hazard ratio, 2.13 [95% CI, 1.88-2.41]). There was no interaction between AVC and sex (P=0.31) for their association with AS. Women and men had similar adjusted hazards for incident AS across AVC categories, and for those with AVC ≥300, the hazard ratio was 134.9 (95% CI, 45.1-403.9) for women and 132.8 (95% CI, 6.2-274.9) for men.

CONCLUSIONS

The association of AVC with the long-term risk of incident AS was similar for women and men, further supporting the utility of AVC as a prognostic marker for incident AS.