Sex-Related Differences in Calcific Aortic Stenosis
Aortic valve stenosis (AS) is a common valve disease that increases in prevalence with aging. AS results in progressive calcium deposition, decreased cusp excursion, and stenosis, and the majority of the weight of an operatively excised valve with AS is thought to be the result of calcium. Sex-related differences in excised aortic valve weight (AVW) have been studied, and calcific aortic valve stenosis is typically associated with less calcium burden in women than in men.
To address potential confounders in the observed sex differences in AVW and aortic valve calcium burden, Mayo Clinic researchers, first author Jeremy Thaden, M.D., conducted a study published in the European Heart Journal. The study sought to describe sex-related differences in clinical and echocardiographic characteristics of patients undergoing surgery for pure AS, determine clinical, echocardiographic, and valve morphology determinants of AVW, and correlate AVW with pre-operative aortic valve CT calcium score.
The results indicated that aortic valve weight was lower in women even when indexed to body surface area or left ventricular outflow tract (LVOT) area. Using multivariate analysis, male sex, bicuspid valve, and larger LVOT area were the major determinants of increased AVW, along with current cigarette smoking. Diabetes and hypertension were independently associated with lower AVW. Aortic valve calcium correlated well with AVW and was lower in women than in men.
In conclusion, despite the same degree of AS severity, women have less aortic valve calcium and lower AVW compared with men, irrespective of valve morphology. Further, aortic valve calcium is correlated to excised AVW.