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Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study
Caroline S Fox1, Ramachandran S Vasan, Helen Parise
1National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass 01702-5827, USA.
Insights
Mitral annular calcification (MAC) is a significant indicator of increased cardiovascular disease (CVD) risk. This study found that MAC independently predicts higher risks of CVD events and death, highlighting its importance in risk assessment.
Area of Science:
- Cardiology
- Echocardiography
- Public Health
Background:
- Mitral annular calcification (MAC) is linked to stroke and cardiovascular disease (CVD) in prior studies.
- Limited prospective data exist on MAC's association with CVD morbidity and mortality.
Purpose of the Study:
- To prospectively examine the association between MAC and CVD outcomes.
- To assess MAC's relation to CVD incidence, CVD death, and all-cause death over 16 years.
Main Methods:
- Utilized M-mode echocardiography to assess MAC in Framingham Heart Study participants.
- Employed Cox proportional hazards models for risk estimation.
- Followed 1197 subjects for 16 years, analyzing 307 CVD events and 621 deaths.
Main Results:
- 14% of subjects had MAC.
- MAC was independently associated with increased risk of incident CVD (HR 1.5), CVD death (HR 1.6), and all-cause death (HR 1.3).
- Each 1-mm increase in MAC correlated with a ~10% rise in CVD and all-cause mortality risk.
Conclusions:
- Cardiac calcification, specifically MAC, serves as an independent marker of elevated CVD risk.
- Findings emphasize the clinical significance of MAC in predicting adverse cardiovascular outcomes.
Background:
Mitral annular calcification (MAC) has been associated with stroke in longitudinal, community-based cohorts and cardiovascular disease (CVD) outcomes in many small retrospective studies. Prospective data are limited on the relation of MAC with CVD morbidity and mortality.
Methods And Results:
We examined the association between MAC assessed by M-mode echocardiography and the incidence of CVD, CVD death, and all-cause death over 16 years of follow-up in the Framingham Heart Study subjects who attended a routine examination between 1979 and 1981. Cox proportional hazards models were used to estimate hazard ratios (HRs) associated with the presence of MAC for each outcome. Of 1197(445 male, 752 female) subjects who had adequate echocardiographic assessment, 14% had MAC. There were 307 incident CVD events and 621 deaths. In multivariable adjusted analyses, MAC was associated with an increased risk of incident CVD (HR, 1.5; 95% CI, 1.1, 2.0), CVD death (HR, 1.6; 95% CI, 1.1, 2.3), and all-cause death (HR, 1.3; 95% CI, 1.04, 1.6). For each 1-mm increase in MAC, the risk of incident CVD, CVD death, and all-cause death increased by approximately 10%.
Conclusions:
The independent association of MAC with incident CVD and CVD death underscores that cardiac calcification is a marker of increased CVD risk.
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