Association of Aortic Valve Calcium With Dementia and Stroke: The Multi-Ethnic Study of Atherosclerosis

Authors

• Natalie Marrero
• Kunal Jha
• Timothy M Hughes
• Alexander C Razavi
• Jelani K Grant
• Ellen Boakye
• Khalil Anchouche
• Omar Dzaye
• Matthew J Budoff
• Jerome I Rotter
• Xiuqing Guo
• Jie Yao
• Alexis C Wood
• Roger S Blumenthal
• Erin D Michos
• George Thanassoulis
• Wendy S Post
• Michael J Blaha
• Chinwe Ibeh
• Seamus P Whelton

Language

English

Publication Date

10-1-2024

Journal

Atherosclerosis

DOI

10.1016/j.atherosclerosis.2024.117596

PMID

38890039

PMCID

PMC12204566

PubMedCentral® Posted Date

10-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Background and aims: Calcific aortic valve disease is associated with increased thrombin formation, platelet activation, decreased fibrinolysis, and subclinical brain infarcts. We examined the long-term association of aortic valve calcification (AVC) with newly diagnosed dementia and incident stroke in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: AVC was measured using non-contrast cardiac CT at Visit 1. We examined AVC as a continuous (log-transformed) and categorical variable (0, 1-99, 100-299, ≥300). Newly diagnosed dementia was adjudicated using International Classification of Disease codes. Stroke was adjudicated from medical records. We calculated absolute event rates (per 1000 person-years) and multivariable adjusted Cox proportional hazards ratios (HR).

Results: Overall, 6812 participants had AVC quantified with a mean age of 62.1 years old, 52.9 % were women, and the median 10-year estimated atherosclerotic cardiovascular disease (ASCVD) risk was 13.5 %. Participants with AVC >0 were older and less likely to be women compared to those with AVC=0. Over a median 16-year follow-up, there were 535 cases of dementia and 376 cases of stroke. The absolute risk of newly diagnosed dementia increased in a stepwise pattern with higher AVC scores, and stroke increased in a logarithmic pattern. In multivariable analyses, AVC was significantly associated with newly diagnosed dementia as a log-transformed continuous variable (HR 1.09; 95 % CI 1.04-1.14) and persons with AVC ≥300 had nearly a two-fold higher risk (HR 1.77; 95 % CI 1.14-2.76) compared to those with AVC=0. AVC was associated with an increased risk of stroke after adjustment for age, sex, and race/ethnicity, but not after adjustment for ASCVD risk factors.

Conclusions: After multivariable adjustment, AVC >0 was significantly associated with an increased risk of newly diagnosed dementia, but not incident stroke. This suggests that AVC may be an important risk factor for the long-term risk of dementia beyond traditional ASCVD risk factors.

Keywords

Humans, Female, Male, Aged, Aortic Valve, Stroke, Dementia, Middle Aged, Calcinosis, Risk Factors, Aged, 80 and over, Aortic Valve Stenosis, Incidence, United States, Proportional Hazards Models, Risk Assessment, Time Factors, Prospective Studies, Atherosclerosis, Multivariate Analysis, Tomography, X-Ray Computed

Published Open-Access

yes

Recommended Citation

Marrero, Natalie; Jha, Kunal; Hughes, Timothy M; et al., "Association of Aortic Valve Calcium With Dementia and Stroke: The Multi-Ethnic Study of Atherosclerosis" (2024). Faculty, Staff and Students Publications. 7732.
https://digitalcommons.library.tmc.edu/baylor_docs/7732