Sex differences in the prevalence and risk factors for aortic valve calcification in the general population

Aortic valve calcification (AVC) is a disease process driven by inflammation and lipid infiltration, serving as a precursor to aortic stenosis. While male sex has been implicated as a risk factor for AVC, sex-specific differences, particularly among younger individuals in the general population, are not well characterised.

The Swedish CArdioPulmonary BioImage Study was used, comprising 30 154 individuals between 50 and 64 years, randomly selected from the general population. Study participants were part of a prospective cohort and underwent laboratory tests, clinical examinations, comprehensive questionnaires and cardiac CT. Cardiac CT was used for determining presence of AVC. Logistic regression analysis was performed to assess associations between traditional cardiovascular risk factors and AVC.

In total, 29 160 participants were included and AVC was found in 1291 men (9%) and 730 women (5%). Male sex was an independent predictor of AVC (OR 1.91; 95% CI 1.71 to 2.13). Characteristics associated with AVC were similar between the sexes. In the adjusted analyses, lipoprotein(a), hyperlipidaemia, hypertension and smoking were strongly associated with AVC, whereas low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, glycated haemoglobin and estimated glomerular filtration rate showed no significant associations with AVC. Higher body mass index (BMI) was associated with AVC in men but not women.

Male sex was independently associated with AVC, and the prevalence of AVC was nearly twice as high in men as in women. Traditional cardiovascular risk factors, including lipoprotein(a), hyperlipidaemia, hypertension and smoking, were associated with AVC, with similar associations between sexes, except for BMI, which was associated with AVC in men but not in women.