Correlates of Valvular Ossification in Patients with Aortic Valve Stenosis

Valvular calcification may include a regulated process of active ossification; however, the determinants of ossification are unclear. The aim of this study was to identify subject and disease characteristics associated with valvular ossification among patients with calcified aortic valves. Medical records were reviewed for variables associated with aortic stenosis and skeletal bone in a series of 195 patients requiring aortic valve excision. Thirty patients had valvular bone on histopathology. Univariate analyses suggested that warfarin therapy (p = 0.004), African American race (p = 0.006), height (p = 0.03), and male sex (p = 0.07) were associated with greater odds of valvular ossification while diabetes was associated with lower odds (p = 0.07). Multivariate analysis demonstrated that warfarin use (OR 5.7; 95% CI: 1.5-21.3; p = 0.009) and African American race (OR 8.3; 95% CI: 1.8-39.0; p = 0.007) were strongly and independently associated with increased odds of valvular ossification. Valvular ossification was not associated with greater ossification of costochondral cartilage on chest radiography. Warfarin therapy and African American race were associated with increased risk of valvular ossification in patients with aortic stenosis. Future studies are needed to confirm this finding and determine if inhibition of matrix GLA protein by warfarin mediates this effect.