Aortic Valve Calcification: Assessment of Cardiovascular Risk Factors and Bone Mineral Density in Patients Undergoing Coronary Angiography

Yıl 2008, Cilt: 15 Sayı: 2, 69 - 74, 01.04.2008

Gülaçan Özgün Tekin Jülide Yağmur Ersoy Kekilli Cengiz Yağmur Ahmet Uçkan Yüksel Aksoy Hasan Turhan Ertan Yetkin Ramazan Özdemir Feridun Koşar

Öz

Objective: Aortic valve calcification (AVC) appears to have high incidence of cardiovascular risk factors and can be considered as a manifestation of atherosclerosis. Association between low bone mineral density (BMD) and increased prevalence of aortic calcification has been shown in older women mainly in population based studies. However, some studies have reported lack of association between BMD and aortic calcification. Accordingly we aimed to assess AVC in patients undergoing coronary angiography and to compare cardiovascular risk factors and BMD of patients with and without AVC. Materials and Methods: Study population consisted of 585 consecutive patients (372 male, 213 female mean age 5910) who underwent coronary angiography. Complete transthoracic echocardiography studies were performed in all patients. AVC was defined as bright dense echos of >1 mm size on one or more cusps and decreased mobility of the involved cusp. All patients were referred to Nuclear Medicine department to measure bone mineral density (T score) using the dual energy x-ray absorptiometry method (DEXA). Age, sex, body mass index, hypertension, diabetes mellitus, coronary artery disease, hypercholesterolemia, and smoking status were recorded in all patients. Results: The prevalence of AVC in our study population was found to be 27% (160/585). There were not statistically significant differences between two groups in respect to diabetes mellitus, hypercholesterolemia, smoking status (p>0.05 for all). Age and hypertension were found to be independent positive risk factors for AVC, where as body mass index was found to be negatively and independently associated with AVC. Presence of coronary artery disease was significantly higher in patients with AVC compared to those without AVC however it was not found to be associated with AVC. Neither T score nor age- and gender adjusted T score were found to be associated with AVC. Conclusion: We have demonstrated that age, hypertension, and body mass index are independently associated with AVC. Age-gender adjusted T score measuring BMD is found to be independent of AVC. Although we have shown absence of association between coronary artery disease and AVC, this issue remains to be clarified in further clinical studies. Key words: Aortic valve calcification, Bone mineral density, Cardiovascular risk factors, Coronary artery disease, Atherosclerosis, Osteoporosis, T score

Anahtar Kelimeler

Aortic valve calcification, Bone mineral density, Cardiovascular risk factors, Coronary artery disease, Atherosclerosis, Osteoporosis, T score

Aort Kapak kalsifikasyonu: Koroner Anjiografi Yapılan Hastalarda Kardiyovasküler Risk Faktörlerinin ve Kemik Mineral Dansitesinin Değerlendirilmesi

Öz

Amaç: Aort kapak kalsifikasyonu (AKK) yüksek kardiyovasküler risk insidansına sahip görünmekte olup, aterosklerozun bir sonucu olarak kabul edilebilir. Düşük kemik mineral dansitesi ve artmış aort kalsifikasyon prevalensi arasındaki ilişki esas olarak toplum tabanlı çalışmalarda yaşlı bayanlarda gösterilmiştir. Ancak bazı çalışmalar kemik mineral dansitesi ile aort kalsifikasyonu arasında ilişki olmadığını bildirmiştir. Bu yüzden. biz koroner angiografi yapılan hastalarda AKK'nu değerlendirmeyi ve AKK olan ve olmayan hastaların kardiyovasküler risk faktörlerini ve kemik mineral dansitelerini karşılaştırmayı amaçladık. Materyal ve metod: Çalışma populasyonu koroner angiografi yapılan 585 ardışık hasta (372 erkek, 213 kadın, ortalama yaş=59±10 yıl) içeriyordu. Bütün hastalara transtorasik ekokardiyografik inceleme yapıldı. AKK bir yada daha fazla küspis üzerinde birden fazla parlak yoğun ekoların izlenmesi ve tutulan küspisin azalmış hareketi olarak tanımlandı. Bütün hastalar dual energy x-ray absorpsiyometri (DEXA) yöntemi ile kemik mineral dansitesi (T scor) ölçümü için Nükleer Tıp bölümüne yönlendirildi. Tüm hastalarda yaş, cinsiyet, vücut kitle indeksi, hipertansiyon, diyabetes mellitus, koroner arter hastalığı, hiperkolesterolemi ve sigara içiciliği kaydedildi. Bulgular: Çalışmamızda AKK prevalensı %27 (160/585) bulundu. Her iki grup arasında diyabetes mellitus, hiperkolesterolemi ve sigara içiciliği yönünden istatistiksel olarak anlamlı fark yoktu (p>0.05 hepsi için). Yaş ve hipertansiyon AKK için bağımsız risk faktörü olmasına karşılık vücut kitle indeksi AKK için bağımsız ve negatif risk faktörü olarak saptandı. AKK ile ilişkili bulunmasada AKK olan grupta koroner arter hastalığı anlamlı oranda yüksek saptandı. Ne T skoru, ne de yaş ve cinsiyete uyarlanmış T skoru AKK ile ilişkili bulunmadı. Sonuç: Biz bu çalışmada yaş, hipertansiyon ve vücut kitle indeksi ile AKK arasında bağımsız ilişki olduğunu gösterdik. Kemik mineral dansite ölçümünde yaş-cinsiyet uyarlanmış T skoru AKK ile ilişkisiz bulundu. Her ne kadar çalışmamızda koroner arter hastalığı ile AKK arasında ilişki olmadığı gösterilmiş olsada bu konunun aydınlanması için ileri çalışmalara ihtiyaç vardır. Anahtar kelimeler: Aort kapak kalsifikasyonu, Kemik mineral dansitesi, Kardiyovasküler risk faktörleri, Koroner arter hastalığı, Ateroskleroz, Osteoporoz, T scor

Anahtar Kelimeler

Aort kapak kalsifikasyonu, Kemik mineral dansitesi, Kardiyovasküler risk faktörleri, Koroner arter hastalığı, Ateroskleroz, Osteoporoz, T scor

Kaynakça

• Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM. Clinical factors associated with calcific aortic valve disease: Cardiovascular Health Study. J Am Coll Cardiol 1997;29:630–4.
• Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999;341:142–7.
• Aksoy Y, Yagmur C, Tekin GO, Yagmur J, Topal E, Kekilli E, Turhan H, Kosar F, Yetkin E. Aortic valve calcification: association with bone mineral density and cardiovascular risk factors. Coron Artery Dis 2005;16:379-83.
• Aronow WS, Schwartz KS, Koenigsberg M. Correlation of serum lipids, calcium, and phosphorus, diabetes mellitus and history of systemic hypertension with presence or absence of calcified or thickened aortic cusps or root in elderly patients. Am J Cardiol 1987;59:998–9.
• Deutscher S, Rockette HE, Krishnaswami V. Diabetes and hypercholesterolemia among patients with calcific stenosis. J Chron Dis 1994;37:407–15.
• Gotoh T, Kuroda T, Yamasawa M, Nishinaga M, Mitsuhashi T, Seino Y, Nagoh N, Kayaba K, Yamada S, Matsuo H, et al. Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study). Am J Cardiol 1995;76:928–32.
• Lindroos M, Kupari M, Valvanne J, Strandberg T, Heikkilä J, Tilvis R. Factors associated with calcific aortic valve degeneration in the elderly. Eur Heart J ;15:865–70. Mohler ER, Sheridan MJ, Nichols R, Harvey WP, Waller BF. Development and progression of aortic valve stenosis: atherosclerotic risk factors — a causal relationship? A clinical morphological study. Clin Cardiol 1991;14:995–9.
• Rajamannan NM, Subramaniam M, Springett M, Sebo TC, Niekrasz M, McConnell JP, Singh RJ, Stone NJ, Bonow RO, Spelsberg TC. Atorvastatin inhibits hypercholesterolemia-induced cellular proliferation and bone matrix production in the rabbit aortic valve. Circulation 2002;5:2660–5.
• Watson KE, Boström K, Ravindranath R, Lam T, Norton B, Demer LL. TGF- beta 1 and 25-hydroxycholesterol stimulate osteoblast-like vascular cell to calcify. J Clin Invest 1994;93:2106–13.
• Barengolts EI, Berman M, Kukreja SC, Kouznetsova T, Lin C, Chomka EV. Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int 1998;62:209–21.
• Jie KG, Bots ML, Vermeer C, Witteman JC, Grobbee DE. Vitamin K status and bone mass in women with and without aortic atherosclerosis: a population- based study. Calcif Tissue Int 2006;59:352–6.
• Banks LM, Lees B, MacSweeney JE, Stevenson JC. Effect of degenerative spinal and aortic calcification on bone density measurements in post-menopausal women: links between osteoporosis and cardiovascular disease? Eur J Clin Invest 1994;24:813-7.
• Frye MA, Melton LJ 3rd, Bryant SC, Fitzpatrick LA, Wahner HW, Schwartz RS, Riggs BL.Osteoporosis and calcification of the aorta. Bone Miner. 1992;19:185
• Vogt MT, San Valentin R, Forrest KY, Nevitt MC, Cauley JA. Bone mineral density and aortic calcification: the Study of Osteoporotic Fractures. J Am Geriatr Soc 1997;45:140–5.
• Schmid K, McSharry WO, Pameijer CH, Binette JP. Chemical and physicochemical studies on the mineral deposits of the human atherosclerotic aorta. Atherosclerosis 1980;37:199–210.
• Aoyagi K, Ross PD, Orloff J, Davis JW, Katagiri H, Wasnich RD. Low bone density is not associated with aortic calcification. Calcif Tissue Int 2001;69:20–4.
• Drinka PJ, Bauwens SF, DeSmet AA. Lack of correlation between aortic calcification and bone density. Wis Med J 1992;91:299–301.
• World Health Organization. WHO Technical Report Series 843. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva, Switzerland: World Health Organization; 1994.
• Adler Y, Vaturi M, Herz I, Iakobishvili Z, Toaf J, Fink N, Battler A, Sagie A. Nonobstructive aortic valve calcification: a window to significant coronary artery disease. Atherosclerosis 2002;161:193-7.
• Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation. 2006;113:8616
• Aronow WS, Ahn C, Shirani J, Kronzon I. Comparison of frequency of new coronary events in older subjects with and without valvular aortic sclerosis. Am J Cardiol 1999;83:599–600.
• Kiel DP, Kauppila LI, Cupples LA, Hannan MT, O'Donnell CJ, Wilson PW. Bone loss and the progression of abdominal aortic calcification over a 25-year period: the Framingham Heart Study. Calcif Tissue Int 2001;68:271–6
• Bakhireva LN, Barrett-Connor EL, Laughlin GA, Kritz-Silverstein D. Differences in association of bone mineral density with coronary artery calcification in men and women: the Rancho Bernardo Study. Menopause ;12:691-8. Boukhris R, Becker KL. Calcification of the aorta and osteoporosis. JAMA ;219:1307–11.
• Kammerer CM, Dualan AA, Samollow PB, Périssé AR, Bauer RL, MacCluer JW, O'Leary DH, Mitchell BD. Bone mineral density, carotid artery intimal medial thickness, and the vitamin D receptor BsmI polymorphism in Mexican American women. Calcif Tissue Int 2004;75:292-8.
• Von der Recke P, Hansen MA, Hassager C. The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 1999;106:273–8.