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Published on: August 28, 2018
The Association of Mitral Annular Calcification With Cardiovascular and Noncardiovascular Outcomes: The Multi-Ethnic
Ebenezer Oni1, Ellen Boakye2, Gregg S Pressman3
1Division of Cardiology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
Insights
Mitral annular calcification (MAC) is linked to reduced bone mineral density and increased risk of dementia and mortality in a diverse population. This finding suggests MAC may indicate broader health issues beyond cardiovascular disease.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Mitral annular calcification (MAC) is a potential indicator of biologic aging.
- The association between MAC and noncardiovascular outcomes like bone mineral density (BMD), renal failure, and dementia is not well-established in diverse cohorts.
Purpose of the Study:
- To investigate the association of MAC with noncardiovascular measures, including BMD, walking pace, incident renal failure, dementia, and mortality in a multiracial cohort.
Main Methods:
- Utilized data from 6,814 participants in the Multi-Ethnic Study of Atherosclerosis without baseline cardiovascular disease.
- Assessed MAC using cardiac computed tomography.
- Employed multivariable regression and Cox proportional hazards models to evaluate associations with BMD, walking pace, renal failure, dementia, and mortality.
Main Results:
- MAC prevalence was 9.5%, higher in women.
- MAC was associated with lower BMD (coefficient -0.04) and significantly higher hazards of dementia (HR 1.36) and all-cause mortality (HR 1.47).
- Participants with MAC showed increased risks for cardiovascular and noncardiovascular mortality.
Conclusions:
- Mitral annular calcification is associated with reduced bone mineral density, dementia, and increased all-cause, cardiovascular, and noncardiovascular mortality.
- MAC may serve as a marker for broader metabolic and inflammatory factors contributing to noncardiovascular risks and mortality.
- These findings highlight the systemic implications of MAC beyond its role in atherosclerotic burden.
Abstract:
Mitral annular calcification (MAC) may be a potential marker of biologic aging. However, the association of MAC with noncardiovascular measures, including bone mineral density (BMD), incident renal failure, dementia, and noncardiovascular mortality, is not well-studied in a multiracial cohort. We used data from 6,814 participants (mean age: 62.2 ± 10.2 years, 52.9% women) without cardiovascular disease at baseline in the Multi-Ethnic Study of Atherosclerosis. MAC was assessed with noncontrast cardiac computed tomography at study baseline. Using multivariable-adjusted linear and logistic regression, we assessed the cross-sectional association of MAC with BMD and walking pace. Furthermore, using Cox proportional hazards, we evaluated the association of MAC with incident renal failure, dementia, and all-cause mortality. In addition, we assessed the association of MAC with cardiovascular and noncardiovascular mortality using competing risks regression. The prevalence of MAC was 9.5% and was higher in women (10.7%) than in men (8.0%). MAC was associated with low BMD (coefficient -0.04, 95% confidence interval [CI] -0.06 to -0.02), with significant interaction by gender (p-interaction = 0.035). MAC was, however, not associated with impaired walking pace (odds ratio 1.09, 95% CI 0.89 to 1.33). Compared with participants without MAC, those with MAC had an increased risk of incident renal failure, albeit nonsignificant (hazard ratio [HR] 1.18, 95% CI 0.95 to 1.45), and a significantly higher hazards of dementia (HR 1.36, 95% CI 1.10 to 1.70). In addition, participants with MAC had a substantially higher risk of all-cause (HR 1.47, 95% CI 1.29 to 1.69), cardiovascular (subdistribution HR 1.39, 95% CI 1.04 to 1.87), and noncardiovascular mortality (subdistribution HR 1.35, 95% CI 1.14 to 1.60) than those without MAC. MAC ≥100 versus <100 was significantly associated with reduced BMD, incident renal failure, dementia, all-cause, cardiovascular, and noncardiovascular mortality. In conclusion, MAC was associated with reduced BMD and dementia and all-cause, cardiovascular, and noncardiovascular mortality in this multiracial cohort. Thus, MAC may be a marker not only for atherosclerotic burden but also for other metabolic and inflammatory factors that increase the risk of noncardiovascular outcomes and death from other causes.
