Author + information
- Received August 22, 2016
- Revision received December 24, 2016
- Accepted January 3, 2017
- Published online March 20, 2017.
- Andrew T. Yan, MDa,∗ (, )
- Maria Koh, MScb,
- Kelvin K. Chan, MD, MScc,
- Helen Guo, MScb,
- David A. Alter, MD, PhDb,d,
- Peter C. Austin, PhDb,
- Jack V. Tu, MD, PhDb,e,
- Harindra C. Wijeysundera, MD, PhDb,e and
- Dennis T. Ko, MD, MScb,e
- aTerrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada, University of Toronto, Toronto, Ontario, Canada
- bInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- cSunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
- dCardiovascular Prevention and Rehabilitation Program, University Health Network-Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- eDepartment of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Andrew T. Yan, Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Room 6-030, Donnelly, Toronto, Ontario M5B 1W8, Canada.
Background Few longitudinal studies have delineated the association between traditional cardiovascular risk factors and development of aortic stenosis (AS).
Objectives The authors examined the association between traditional cardiovascular risk factors and incident severe AS in a large, unselected elderly population.
Methods This observational cohort study used multiple linked health care population-based databases of individuals older than 65 years on April 1, 2002, without prior valvular disease, coronary artery disease, heart failure, cardiac arrhythmia, cerebrovascular disease, congenital heart disease, or admissions with cardiac symptoms. The relationship between hypertension (HTN), diabetes, dyslipidemia, and incident severe AS requiring hospitalization or surgical or interventional treatment was examined.
Results Among 1.12 million individuals followed for a median of 13 years, 20,995 subjects developed severe AS. Overall absolute incidence was 144 per 100,000 person-years (169 and 127 per 100,000 person-years in men and women, respectively). In cause-specific hazard models, HTN (adjusted hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.66 to 1.76), diabetes (HR: 1.49; 95% CI: 1.44 to 1.54), and dyslipidemia (HR: 1.17; 95% CI: 1.14 to 1.21) were all significantly associated with increased risk of developing severe AS (all p < 0.001). There was a positive dose-response relationship between the number and duration of cardiac risk factors and risk of AS. In the Fine-Gray model, all 3 risk factors were independently associated with a higher incidence of AS. The population-attributable risk of AS associated with 3 cardiac risk factors was 34.4% (95% CI: 32.8 to 36.0).
Conclusions HTN, diabetes, and dyslipidemia have independent and dose-response associations with incident AS in an unselected population of older individuals, and together accounted for approximately one-third of the incidence of severe AS.
This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. This work was supported by a grant-in-aid from the Heart and Stroke Foundation (HSF) of Canada. The Cardiovascular Health in Ambulatory Care Research Team initiative is funded by an operating grant from the Institute of Circulatory and Respiratory Health (ICRH)-Canadian Institutes of Health Research (CIHR) Chronic Diseases Team (grant no. TCA 118349) and a CIHR Foundation grant. Drs. Alter and Austin are supported by Career Investigator Awards from the HSF, Ontario office. Dr. Wijeysundera is supported by a Distinguished Clinical Scientist Award from the HSF of Canada. Dr. Tu is supported by a Canada Research Chair in Health Services Research and an Eaton Family Scholar award. Dr. Ko is supported by an HSF Ontario Mid-Career Investigator Award. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 22, 2016.
- Revision received December 24, 2016.
- Accepted January 3, 2017.
- 2017 American College of Cardiology Foundation