|Title||Association of Mild Valvular Lesions With Long-term Cardiovascular Outcomes Among Black Adults.|
|Publication Type||Journal Article|
|Year of Publication||2022|
|Authors||Matsushita K, Gao Y, Rubin J, Kirtane AJ, Kodali S, Selvin E, Alonso A, Leon MB, Solomon SD, Coresh J, Fox ER, Shah AM|
|Journal||JAMA Netw Open|
|Date Published||2022 05 02|
|Keywords||Adult, Aortic Valve Insufficiency, Atrial Fibrillation, Cohort Studies, Female, Heart Failure, Humans, Middle Aged, Mitral Valve Insufficiency, Sclerosis, Stroke|
Importance: Little is known about the long-term outcomes of mild valvular lesions.
Objective: To examine the associations of 3 major types of valvular lesions (aortic stenosis, trace or mild aortic regurgitation, and trace or mild mitral regurgitation) with risk of cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, and atrial fibrillation.
Design, Setting, and Participants: This cohort study analyzed data from the ongoing Atherosclerosis Risk in Communities study and focused on Black participants in the Jackson, Mississippi, site who underwent echocardiography at visit 3 from 1993 to 1995. Data analysis was conducted between April 2021 and February 2022.
Exposures: Three valvular lesions were analyzed: aortic sclerosis, aortic regurgitation (trace or mild), and mitral regurgitation (trace or mild).
Main Outcomes and Measures: The outcomes were cardiovascular mortality, coronary heart disease, heart failure, stroke, and atrial fibrillation. Multivariable Cox proportional hazards regression models were used to examine the independent associations between the 3 valvular lesions and these outcomes.
Results: A total of 2106 Black participants were included, with a mean (SD) age of 59.1 (5.6) years and 1354 women (64.3%). The baseline prevalence was 7.7% for aortic sclerosis, 15.1% for aortic regurgitation (6.1% with trace, and 9.0% with mild), and 43.0% for mitral regurgitation (29.4% with trace, and 13.6% with mild). During a median (interquartile interval) follow-up of 22.5 (15.6-23.5) years, 890 participants developed at least 1 cardiovascular outcome. Each valvular lesion was significantly associated with at least 1 cardiovascular outcome: aortic sclerosis was associated with cardiovascular mortality (adjusted hazard ratio [HR], 1.54; 95% CI, 1.06-2.22), mild mitral regurgitation was associated with atrial fibrillation (HR, 1.47; 95% CI, 1.09-1.99), and trace or mild aortic regurgitation was associated with all outcomes (HRs ranging from 1.45 [95% CI, 1.17-1.81] to 1.75 [95% CI, 1.29-2.37]) except stroke. The total number of valvular lesions had graded associations with all cardiovascular outcomes except stroke: the HR of cardiovascular mortality was 1.77 (95% CI, 1.18-2.65) for those with 2 to 3 lesions and was 1.44 (95% CI, 1.05-1.96) for those with 1 lesion vs no lesions.
Conclusions and Relevance: Results of this study indicate an association between valvular lesions, even at mild stage, and a long-term risk of cardiovascular events, suggesting the importance of recognizing and monitoring these valvular conditions.
|Alternate Journal||JAMA Netw Open|
|PubMed Central ID||PMC9099428|
|Grant List||HHSN268201700001I / HL / NHLBI NIH HHS / United States |
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
K24 HL148521 / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
K24 HL152440 / HL / NHLBI NIH HHS / United States