Published online before print March 10, 2003, doi: 10.1161/01.CIR.0000058168.26163.BC
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(Circulation. 2003;107:1492.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Mitral Annular Calcification Predicts Cardiovascular Morbidity and Mortality
The Framingham Heart Study
From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (all authors), Framingham, Mass; the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Mass (C.J.O.); the Cardiology Section, Department of Medicine and Preventive Medicine Section, Boston University School of Medicine, Boston, Mass (R.S.V., D.L., E.J.B.); the Department of Mathematics, Boston University, Boston, Mass (H.P., R.D.); and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (C.S.F., D.L., C.J.O.).
Correspondence to Emelia J. Benjamin, MD, ScM, Framingham Heart Study, 73 Mt Wayte Ave, Suite #2, Framingham, MA 01702-5827. E-mail emelia{at}fram.nhlbi.nih.gov
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 
10%.
Conclusions— The independent association of MAC with incident CVD and CVD death underscores that cardiac calcification is a marker of increased CVD risk.
Key Words: calcium • echocardiography • cardiovascular diseases • mortality
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