Aortic and mitral stenosis are among the most common forms of valvular heart disease affecting the elderly. Valve calcification precedes clinical stenosis and may represent an important intermediate phenotype for valve disease.(1) Previously considered a degenerative consequence of aging, valve calcification and the resulting valvular stenosis are now recognized as “active” processes with marked histological similarities to atherosclerosis.(2–7) However, the failure of lipid-lowering strategies to prevent or slow the progression of valvular disease has raised questions about the role of atherosclerosis risk factors in valvular stenosis.(8–11) Improved understanding of the role of cardiovascular risk factors in valvular disease and the appropriate timing for their control could provide insights into the prevention of valvular disease. Atherosclerosis risk factors such as lipoproteins, cigarette smoking and metabolic syndrome have been associated with valvular calcium in several cross-sectional studies but in only few prospective studies. Prospective studies to date have been limited by short-term follow-up(2,12,13) and single assessments of risk factors(14) which may underestimate the long-term cumulative effects of cardiovascular risk factors on valve calcium. In addition, contemporary rates of treatment for cholesterol and other risk factors may attenuate the associations of valvular disease with risk factors. Prospective, longitudinal studies with repeated measurement of risk factors could overcome these limitations. Accordingly, using over 25 years of longitudinal data from the Framingham Offspring study, we sought to evaluate the association of long-term exposure to atherosclerosis risk factors and the prevalence of aortic valve and mitral valve calcium in a community-based sample. We also sought to establish the association between an adverse risk factor profile in early to mid-adulthood and valvular calcification measured nearly three decades later.
