July 19, 1999 WINSTON-SALEM, N.C. -- For decades, doctors have believed that early signs of aortic heart valve disease were harmless if the valve was functioning normally. But research by a Wake Forest University Baptist Medical Center cardiologist and colleagues at the University of Washington and Mayo Clinic suggests that the condition significantly increases the risk of heart attack, stroke, angina and even death in older adults.
The aortic valve could prove to be a "window" to the heart's arteries and checking its health with a stethoscope could be an early way to screen patients for heart vessel disease, suggests an editorial accompanying the research report in this week's New England Journal of Medicine.
Aortic sclerosis, the early buildup of calcium deposits that causes the valve to be thicker and more rigid than normal -- but doesn't significantly affect its function -- is associated with a 50 percent increase in risk of heart attack and death from heart-related causes, reported the researchers.
"We were surprised that this low level of valve disease appeared to have such a large effect, especially in such a short period of time," said Dalane W. Kitzman, M.D., associate professor of cardiology at Wake Forest University Baptist Medical Center. "These findings are significant because about one in four people over age 65 has aortic sclerosis."
Doctors already knew that when calcium deposits reduce the size of the aortic valve's opening (aortic stenosis), the prognosis is poor without surgical treatment. Earlier studies had also suggested that minor valve disease gradually progresses to aortic stenosis in many patients. This is the first study, however, to link early aortic valve disease with increased risk of death and heart attacks.
The researchers called for additional studies to learn how aortic sclerosis and events such as heart attack and stroke are related: Is early valve disease a marker for heart vessel disease? Or, does the valve disease somehow cause heart attacks, strokes, angina and heart failure? The answers could lead to a new way to screen for heart vessel disease.
"It is intriguing to think that a new screening procedure for assessing coronary risk ... may simply consist of the careful use of a stethoscope," wrote Blase A. Carabello, M.D., with the Houston Veterans Affairs Medical Center, in an accompanying editorial.
While the research study used ultrasound to diagnose aortic valve disease, physicians could potentially use a simple stethoscope to detect some cases of aortic sclerosis.
Kitzman and fellow researchers evaluated data from the Cardiovascular Health Study, which involved almost 6,000 older adults in Forsyth County and three other communities. The participants in this observational study had echocardiograms -- ultrasound tests of the heart -- when the study began in 1989.
Using these tests to identify participants with aortic valve disease, the researchers compared the participants' level of aortic disease at the beginning of the study with the number of heart attacks, cases of heart failure, strokes, angina and deaths from heart-related events that occurred during the next five years.
Even after adjusting for other factors that could increase risk, such as age, high blood pressure, high cholesterol, and smoking, the researchers found that in people with no signs of heart disease when the study began, those with aortic sclerosis had a 50 percent greater chance of dying from heart-related causes than those without it.
For participants who had known heart disease when the study began, having aortic sclerosis increased their risk of dying from heart-related causes by 20 percent.
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