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Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective
Onur Baris Dolmaci1,2, Antoine H G Driessen2, Robert J M Klautz1,2
1Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Bicuspid aortic valve (BAV) patients have more cardiovascular risk factors but similar coronary artery disease (CAD) prevalence compared to the general population. Tricuspid aortic valve stenosis, unlike other valve conditions, is linked to increased CAD.
Area of Science:
- Cardiovascular Medicine
- Aortic Valve Disease
- Atherosclerosis Research
Background:
- Bicuspid aortic valve (BAV) is often associated with less atherosclerosis than tricuspid aortic valve (TAV).
- It remains debated whether this observation is due to patient age, risk factor accumulation, or an atheroprotective BAV phenotype.
- This study investigates the atherosclerotic disease burden in BAV and TAV patients compared to the general population.
Purpose of the Study:
- To compare the atherosclerotic disease burden in BAV and TAV patients with age-matched general population cohorts.
- To determine if BAV is an atheroprotective phenotype or if observed differences are due to confounding factors.
- To differentiate the atherosclerotic profile of stenotic versus regurgitant TAV and BAV.
Main Methods:
- Retrospective comparison of coronary artery disease (CAD) prevalence and risk factors in BAV (n=454) and TAV (n=1101) patients undergoing aortic valve surgery.
- Data were sourced from the Dutch general practitioners registry.
- Patients were categorized into BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS), and TAV with AR (TAV-AR), and compared with age-matched general population data.
Main Results:
- Hypertension and hypercholesterolemia were more prevalent in surgical groups than the general population (p<0.001).
- BAV-AoS, BAV-AR, and TAV-AR showed similar CAD incidence to age-matched general populations (p=0.689, p=0.325, p=0.617).
- TAV-AoS demonstrated a significantly higher CAD incidence (21.6%) compared to the general population (14.9%, p<0.001).
Conclusions:
- Tricuspid aortic valve stenosis is part of the atherosclerotic disease spectrum.
- Regurgitant TAV and all BAV phenotypes (stenotic or regurgitant) are not.
- Despite higher cardiovascular risk factor prevalence in BAV patients, their CAD prevalence mirrors the general population.
Objective:
Bicuspid aortic valve (BAV) has been associated with less atherosclerosis as compared with tricuspid aortic valve (TAV) patients. It, however, remains unclear whether this reflects the older age of TAV patients and/or accumulation of atherosclerotic risk factors or that the BAV phenotype is atheroprotective. Therefore, we compared the atherosclerotic disease burden of BAV and TAV patients, with that of the general (age-matched) population.
Methods:
The prevalence of coronary artery disease (CAD) and CAD risk factors in BAV and TAV patients who underwent aortic valve surgery were compared with the Dutch general practitioners registry data. BAV (n=454) and TAV (n=1101) patients were divided into four groups: BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS) and TAV with AR (TAV-AR). The atherosclerotic disease burden of each group was compared with that of the corresponding age cohort for the general population.
Results:
CAD risk factors hypertension and hypercholesterolaemia were more prevalent in the surgery groups than the age-matched general population (all p<0.001). All BAVs (BAV-AoS and BAV-AR) and TAV-AR had a similar incidence of CAD history as compared to the age-matched general populations (p=0.689, p=0.325 and p=0.617 respectively), whereas TAV-AoS had a higher incidence (21.6% versus 14.9% in the age-matched general population, p<0.001).
Conclusions:
Stenotic TAV disease is part of the atherosclerotic disease spectrum, while regurgitant TAV and all BAVs are not. Although the prevalence of cardiovascular risk factors is higher in all BAV patients, the prevalence of CAD is similar to the general population.
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