Body mass index and waist-hip ratio – Risk factors for aortic valve disease: The atherosclerosis risk in communities (ARIC) study

Elevated body mass index (BMI) has been associated with increased risk of aortic valve stenosis (AS) in observational and Mendelian randomization studies; however, its association, and that of waist-hip ratio (WHR), with aortic valve insufficiency (AI) remains unclear. We investigated the association of BMI and WHR with incident aortic valve disease (AVD) in the ARIC Study. We analyzed ARIC participants with echocardiograms at Visits 5 (2011-13) and 7 (2018-19). BMI and WHR were assessed at Visit 5. Incident AVD between Visits 5 and 7 was categorized as aortic valve sclerosis, AI without stenosis, and AS. Multinomial regression models were employed. Among 1,931 participants (mean age of 73.5 ± 4.2 years, 59.7% female, and 23.2% Black), 572 (29.6%) developed AVD (345 aortic valve sclerosis, 159 AI, and 68 AS). Higher BMI was associated with a greater incidence of aortic valve sclerosis (OR: 1.29 per 1-SD (5.08 kg/m2), 95% CI: 1.13-1.48) and AS (OR: 1.28, 95% CI: 1.00-1.63), but not AI (OR: 0.93, 95% CI: 0.75-1.14). Higher WHR was associated with an increased risk of incident aortic valve sclerosis (OR: 1.17 per 1-SD (0.079), 95% CI: 1.00-1.35), AS (OR: 1.44, 95% CI: 1.11-1.85), and also AI (OR: 1.24, 95% CI: 1.01-1.53). Higher BMI is a risk factor for incident aortic valve sclerosis and AS, but not AI. Greater WHR is a risk factor not only for incident aortic valve sclerosis and AS, but also for incident AI. Avoiding abdominal obesity may prevent non-rheumatic AVD in older adults.