Valvular Lesions Associated with Long-Term Cardiovascular Event Risk in Black Patients

Kunihiro Matsushita, MD, PhD

A recent study found mild valvular lesions, including aortic sclerosis, trace or mild aortic regurgitation, and mild mitral regurgitation, were significantly associated with a long-term risk of cardiovascular events in Black individuals.

Adjustments for potential confounders revealed each valvular lesions remained associated with a least 1 of the cardiovascular outcomes: aortic sclerosis with cardiovascular mortality, trace or mild aortic regurgitation with all outcomes except stroke, and mild mitral regurgitation with atrial fibrillation

“The results of this study suggest the importance of recognizing and monitoring individuals with these valvular conditions,” wrote study author Kunihiro Matsushita, MD, PhD, Welch Center for Prevention, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.

The current cohort study included 25-years of follow-up data from the Atherosclerosis Risk in Communities (ARIC) study to track the association of 3 major types of valvular lesions at mild stage with risk of cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, and atrial fibrillation.

Investigators analyzed data from the ongoing study, focusing on Black participants in the Jackson, Mississippi study site who underwent echocardiography at visit 3 from 1993 to 1995. Analysis occurred between April 2021 - February 2022, with multivariable Cox proportional hazards regression models used to examine the independent associations between the 3 valvular lesions and cardiovascular outcomes.

The study included a total of 2106 Black participants, with a mean age of 59.1 years and with 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), investigators observed.

At a median follow-up of 22.5 years, a total of 890 participants developed at least 1 of the cardiovascular outcomes, with the most frequent being heart failure (n = 575; 27.3%). Investigators found aortic sclerosis showed independent associations with cardiovascular mortality (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.06 - 2.22) and mitral regurgitation showed an association with atrial fibrillation (adjusted HR, 1.47; 95% CI, 1.09 - 1.99).

Investigators further noted aortic regurgitation showed independent associations with all individuals outcomes except for stroke, with adjusted HRs ranging from 1.45 (95% CI, 1.17 - 1.81) to 1.75 (95% CI, 1.29 - 2.37).

Then, the total number of valvular lesions had graded associations with all cardiovascular outcomes, except for stroke. Data show the HR of cardiovascular mortality was 1.77 (95% CI, 1.18 - 2.65) for those with 2 to 3 lesions and 1.44 (95% CI, 1.05 - 1.96) for those with 1 lesion vs no lesions.

Regarding absolute risk, the 20-year survival free of cardiovascular mortality was 74.9% in participants with 2 to 3 lesions, 85.7% in participants with 1 lesion, and 92.6% in participants with no lesions.

The study, “Association of Mild Valvular Lesions with Long-term Cardiovascular Outcomes Among Black Adults,” was published in JAMA Network Open.