埼玉医科大学雑誌 第31巻 第1号 (2004年1月) 67-72頁 ◇論文(図表を含む全文)は，PDFファイルとなっています．
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Correlation Between Calcific Aortic Valvular Changes and Atherosclerosis in Carotid Arteries in Elderly Patients with Aortic Stenosis
Harutaka Nagasaki (Division of Cardiology, Saitama Medical School, Moroyama, Iruma-gun, Saitama 350-0495, Japan)
To examine the association among the sclerotic and calcified changes in the aortic valve, atherosclerotic changes in carotid arteries and cardiovascular risk factors in the elderly patients (>60 years old) with aortic stenosis (AS)<1.5 cm2(aortic valve area), 49 consecutive patients (average 75.5 years old, 23 male and 26 female) were prospectively studied. The degree of calcification of the aortic valve was classified into four groups as follows, group I; no calcification, group II; mildly calcified (small isolated spots), group III; moderately calcified (multiple larger spots), and group IV; heavily calcified (extensive thickening and calcification of all cusp). We quantitatively evaluated the carotid atherosclerosis by using carotid ultrasonography. The upper limit of normal for the IMCT (intima-media complex thickening) was defined as 1.0 mm, and lesions with an IMCT≧1.1 mm were defined as atheromatous plaques. The traditional cardiovascular risk factors (smoking, hypertension, total cholesterol and HDL-cholesterol, diabetes) and high-sensitivity CRP and fibrin were simultaneously assessed. All patients had the calcified aortic valve. The patients in group III (n=22) and IV (n=18) were 81% of patients studied. Twenty-three (66%) of 35 patients who underwent carotid ultrasonography had atheromatous lesions. There was no significant correlation between calcific aortic valve changes and stenotic severity in this series. Although the increased LDL-cholesterol level, decreased HDL-cholesterol level and increased HbA1c% were significantly associated with severity of atherosclerotic changes in carotid arteries, they were not correlated with the severity of calcific aortic valvular changes. In conclusion, severity of calcific valvular changes in the elderly patients with aortic stenosis were not associated with cardiovascular risk factors, but carotid atherosclerosis was significantly correlated with them. These results suggest the difference in pathogenesis and development between calcific changes in aortic stenosis and carotid atherosclerosis in the elderly populations.
Keywords: calcific aortic valvular changes, atherosclerosis in carotid arteries, aortic stenosis, cardiovascular risk factors
J Saitama Med School 2004;31:67-72
(Received November 28, 2003)