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- Title
Association of Mild Valvular Lesions With Long-term Cardiovascular Outcomes Among Black Adults.
- Authors
Matsushita, Kunihiro; Gao, Yumin; Rubin, Jonathan; Kirtane, Ajay J.; Kodali, Susheel; Selvin, Elizabeth; Alonso, Alvaro; Leon, Martin B.; Solomon, Scott D.; Coresh, Josef; Fox, Ervin R.; Shah, Amil M.
- Abstract
This cohort study evaluates the risk of cardiovascular mortality, coronary heart disease, stroke, heart failure, and atrial fibrillation among Black individuals with aortic stenosis as well as trace or mild aortic regurgitation or mitral regurgitation. Key Points: Question: Is there an association between mild valvular lesions, such as aortic sclerosis, aortic regurgitation, and mitral regurgitation, and cardiovascular outcomes? Findings: In this cohort study of 2106 Black participants in the Atherosclerosis Risk in Communities study, aortic sclerosis, trace or mild aortic regurgitation, and mild mitral regurgitation were each significantly associated with a long-term risk of cardiovascular events. A consistent dose-response association between the total number of valvular lesions and cardiovascular risk was also found. Meaning: Findings of this study suggest the importance of recognizing and monitoring individuals with valvular lesions. 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.
- Subjects
MORTALITY risk factors; CARDIOVASCULAR disease related mortality; MITRAL valve insufficiency; HEART valve diseases; STROKE; CONFIDENCE intervals; BLACK people; AORTIC stenosis; CORONARY disease; ATRIAL fibrillation; AORTIC valve insufficiency; HEART failure; LONGITUDINAL method; PROPORTIONAL hazards models; ADULTS
- Publication
JAMA Network Open, 2022, Vol 5, Issue 5, pe2211946
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.11946