Incidence of coronary events in older persons with and without aortic sclerosis

Purpose: We investigated in a prospective study the incidence of new coronary events (CE) in older patients (pts) with and without valvular aortic sclerosis (AS). Methods: In a prospective study of 2,358 older pts, 378 (16%) had valvular aortic stenosis diagnosed by Doppler echocardiography and were excluded from the study. The other 1,980 pts included 625 men and 1,355 women, mean age 81±8 years. Valvular aortic sclerosis was diagnosed if echocardiography showed thickening or calcification of the aortic valve cusps without aortic stenosis. New CE included nonfatal or fatal myocardial infarction or sudden cardiac death. Follow-up for new CE was 46±28 months (range 2 to 157 months). Results: AS was present in 981 of 1,980 pts (50%). Follow-up was 43±27 months in pts with AS and 50±29 months in pts without AS (p=0.0001). New CE developed in 524 of 981 pts (53%) with AS and in 306 of 999 pts (31%) without AS (p<0.0001). Cox regression analysis showed that significant independent risk factors for new CE were prior coronary artery disease (p=0.0001, risk ratio = 2.8), male gender (p=0.0002, risk ratio = 1.3), and AS (p=0.0001, risk ratio = 1.8). Conclusions: Older persons with AS have a higher incidence of new CE than those without AS. Clinical Implications: Prior coronary artery disease, AS, and male gender are risk factors for new CE in older persons.