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Death rates grow with aortic-valve abnormality
Aortic-valve sclerosis is common in the elderly and was thought until recently to be relatively harmless. But the results of a study suggest that it is actually associated with an increased risk of death due to cardiovascular disease.1 The condition is characterized by a thickening and stiffening of the valve leading from the heart to the aorta.
Investigators at the University of Washington in Seattle, Wake Forest University in Winston-Salem, NC, and the Mayo Clinic in Rochester, MN, assessed the EKGs of 5,600 subjects 65 or older.
At baseline, the aortic valve was normal in 70% of subjects, sclerotic but without outflow obstruction in 29%, and stenotic in 2%. After five years, the researchers found a stepwise increase in deaths from cardiovascular causes as well as deaths from other causes with increasing aortic-valve abnormality. Cardiovascular-related deaths were 6% in the group with normal valves, 10% in the groups with sclerotic valves, and nearly 20% in the groups with stenotic valves. Overall mortality was 15% in the normal valve group, 22% in the sclerotic group, and 41% in the stenotic group.
Their conclusion was that aortic sclerosis "is associated with an increase of approximately 50% in the risk of death from cardiovascular causes and the risk of myocardial infarction."
In an editorial accompanying the study, Blase A. Carabello, MD, of the Houston VA Medical Center commented that assessment of aortic sclerosis requires only a stethoscope, as the condition generally causes a slight murmur, and is an easy way to assess risk. But he cautioned that we cannot draw any conclusions about the link between aortic valve disease and risk of mortality. About a quarter of adults over 65 have aortic sclerosis that does not interfere with blood flow.
1. Otto CM, Lind BK, Kitzman DW, et al. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999; 341:142-147.