A Paradoxical Association between Valvular Heart Disease and Coronary Artery Disease: A Study by Covariance Structure Analysis

Background: Pathogenesis of valvular heart disease (VHD) must have been modifying by lifestyle change and alteration in the environment. It is thus conceivable that contemporary VHD is affected largely by atherosclerotic and calcific process, which is similar to that observed in coronary artery disease (CAD). This study was designed to examine a possible comorbid condition of VHD and CAD in the context of aging, gender, and dyslipidemia. Method: Covariance structure analysis were proposed to evaluate a possible comorbid condition of VHD and CAD regarding the effects of aging, gender, and the serum low-density lipoprotein cholesterol (LDL-C) levels in 3,457 inpatients. Result: The path models revealed that aging was associated with VHD and CAD severity (P < .001 for each). There was, however, an inverse association regarding the comorbid condition between VHD and CAD (P < .001). To prove this inverse association, there was a gender difference; females were associated with VHD and males with CAD. In addition, the LDL-C levels were not associated with VHD, whereas those were highly associated with CAD (P < .001). Conclusion: Aging was generally a promoting factor of VHD and CAD; however, the incidence of respective diseases showed a significant conflicting relationship. The differences in gender and the LDL-C levels between VHD and CAD support likely presence of unknown diverse mechanisms on top of the common cascade of atherosclerosis and calcification.