Diabetes and elevated plasma glucose in heart valve calcification and disease: the Copenhagen General Population Study

Abstract Aims The only treatment available for aortic valve stenosis is valve replacement, which makes it important to identify modifiable risk factors. We tested the hypotheses that diabetes and elevated plasma glucose are associated with aortic and mitral valve calcification and aortic valve stenosis, and that these associations are explained partly by elevated plasma triglycerides, hypertension, and body mass index (BMI). Methods and results In the Copenhagen General Population Study with 110 291 individuals, we evaluated risk of aortic valve stenosis and mitral valve regurgitation from health registers, and in a subset of 12 006 cardiac CT scanned individuals aortic and mitral valve calcification. Of individuals with cardiac CT, 3018 (25%) had aortic and 1521 (13%) had mitral valve calcification. For individuals with vs. without diabetes, the multi-variable adjusted odds ratios were 1.67 (95%:1.34–2.08) for aortic and 1.89 (1.48–2.40) for mitral valve calcification. The corresponding hazard ratio was 1.71 (1.44–2.03) for aortic valve stenosis. For individuals with glucose ≥6.6 mmol/L (≥118 mg/dL) vs. ≤5.1 mmol/L (≤92 mg/dL), the multi-variable adjusted odds ratios were 1.27 (1.07–1.52) for aortic and 1.44 (1.18–1.77) for mitral valve calcification. The corresponding hazard ratio was 1.33 (1.12–1.57) for aortic valve stenosis. In the relationship between diabetes and aortic valve stenosis, 4.8% (95% CI: 0.5–11%) of the association was explained by plasma triglycerides, 19% (14–28%) by hypertension, and 27% (18–43%) by BMI. Conclusion Diabetes and elevated plasma glucose were associated with risk of aortic and mitral valve calcification and aortic valve stenosis. The risk of aortic valve stenosis was partly explained by elevated plasma triglycerides, hypertension, and BMI.