Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

J Am Heart Assoc. 2018 Feb 3;7(3):e007234. doi: 10.1161/JAHA.117.007234.


Background: The relationship between ideal cardiovascular health reflected in the cardiovascular health score (CVHS) and valvular heart disease is not known. The purpose of this study was to determine the association of CVHS attainment through midlife to late life with aortic stenosis prevalence and severity in late life.

Methods and results: The following 6 ideal cardiovascular health metrics were assessed in ARIC (Atherosclerosis Risk in Communities) Study participants at 5 examination visits between 1987 and 2013 (visits 1-4 in 1987-1998 and visit 5 in 2011-2013): smoking, body mass index, total cholesterol, blood pressure, physical activity, and blood glucose. Percentage attained CVHS was calculated in 6034 participants as the sum of CVHS at each visit/the maximum possible score. Aortic stenosis was assessed by echocardiography at visit 5 on the basis of the peak aortic valve velocity. Aortic stenosis was categorized sclerosis, mild stenosis, and moderate-to-severe stenosis. Mean age was 76±5 years, 42% were men, and 22% were black. Mean percentage attained CVHS was 63±14%, and the prevalence of aortic stenosis stages were 15.9% for sclerosis, 4.3% for mild stenosis, and 0.7% for moderate-to-severe stenosis. Worse percentage attained CVHS was associated with higher prevalence of aortic sclerosis (P<0.001 for trend), mild stenosis (P<0.001), and moderate-to-severe stenosis (P=0.002), adjusting for age, sex, and race.

Conclusions: Greater attainment of ideal cardiovascular health in midlife to late life is associated with a lower prevalence of aortic sclerosis and stenosis in late life in a large cohort of older adults.

Keywords: aortic stenosis; echocardiography; epidemiology; primary prevention; risk factor.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / pathology*
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / epidemiology*
  • Aortic Valve Stenosis / prevention & control
  • Biomarkers / blood
  • Blood Glucose / analysis
  • Blood Pressure
  • Body Mass Index
  • Calcinosis / diagnostic imaging
  • Calcinosis / epidemiology*
  • Calcinosis / prevention & control
  • Cholesterol / blood
  • Echocardiography, Doppler
  • Exercise
  • Female
  • Geriatric Assessment / methods
  • Health Status*
  • Humans
  • Life Style*
  • Male
  • Prevalence
  • Protective Factors
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Severity of Illness Index
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Smoking Cessation
  • United States / epidemiology


  • Biomarkers
  • Blood Glucose
  • Cholesterol

Supplementary concepts

  • Aortic Valve, Calcification of