Aortic valve calcification across stages of dysglycemia in middle-aged individuals from the general population

Cardiovasc Diabetol. 2025 Mar 5;24(1):105. doi: 10.1186/s12933-025-02634-7.

Abstract

Background: Aortic valve calcification (AVC) is an underlying pathophysiological mechanism in aortic stenosis, which shares many risk factors with diabetes. However, the association between dysglycemia and early stages of AVC remains unclear. The aim was to examine the associations between stages of dysglycemia and signs of AVC among middle-aged individuals from the general population.

Methods: This was a cross-sectional study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) randomly enrolling 30,154 middle-aged men and women from six study sites in Sweden between 2013 and 2018. Glycemic status was based on the World Health Organization criteria (fasting blood glucose and/or HbA1c) and questionnaire-based answers on previous diseases and categorized as normoglycemia, prediabetes, newly detected diabetes and known diabetes. AVC was assessed on cardiac computed tomography (CT) and defined as evident or not.

Results: Of 29,331 individuals with data on glycemic status and AVC available, mean age was 57.5 years and normoglycemia was present in 76%, prediabetes in 16%, newly detected diabetes in 3% and known diabetes in 5%. The prevalence of AVC increased progressively across glycemic categories, particularly in males (8%, 11%, 14% and 17%; P < 0.01) compared to females (5%, 6%, 8% and 9%; P < 0.01). There was an association with AVC already in the early stages of dysglycemia; prediabetes (OR 1.16, 95% CI 1.02-1.31), newly detected diabetes (1.34 [1.05-1.71]) and known diabetes (1.61 [1.34-1.93]) after adjusting for age, sex, smoking, study site, low density lipoprotein-cholesterol and hypertension.

Conclusions: In this large, contemporary, and randomly selected population of middle-aged individuals, prediabetes, newly detected diabetes and known diabetes were all associated with CT-detected AVC. Further studies are warranted to investigate if managing dysglycemia, even in its early stages, may help slow down AVC progression.

Keywords: Aortic stenosis; Aortic valve calcification; Diabetes; Dysglycemia; Epidemiology; Fasting glucose; HbA1c; Prediabetes; Prevention.

Publication types

  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Aortic Valve Stenosis* / diagnostic imaging
  • Aortic Valve Stenosis* / epidemiology
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / pathology
  • Biomarkers / blood
  • Blood Glucose* / metabolism
  • Calcinosis* / diagnostic imaging
  • Calcinosis* / epidemiology
  • Cross-Sectional Studies
  • Diabetes Mellitus* / blood
  • Diabetes Mellitus* / diagnosis
  • Diabetes Mellitus* / epidemiology
  • Female
  • Glucose Metabolism Disorders* / blood
  • Glucose Metabolism Disorders* / diagnosis
  • Glucose Metabolism Disorders* / epidemiology
  • Glycated Hemoglobin / metabolism
  • Humans
  • Male
  • Middle Aged
  • Prediabetic State* / blood
  • Prediabetic State* / diagnosis
  • Prediabetic State* / epidemiology
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Sweden / epidemiology

Substances

  • Blood Glucose
  • Biomarkers
  • hemoglobin A1c protein, human
  • Glycated Hemoglobin

Supplementary concepts

  • Aortic Valve, Calcification of