Elsevier

American Heart Journal

Volume 166, Issue 5, November 2013, Pages 904-912
American Heart Journal

Clinical Investigation
Valvular and Congenital Heart Disease
Risk factors associated with the incidence and progression of mitral annulus calcification: The multi-ethnic study of atherosclerosis

https://doi.org/10.1016/j.ahj.2013.08.015Get rights and content

Background

Significant cardiovascular morbidity has been associated with mitral annulus calcification (MAC), but limited data exist regarding its progression. The purpose of this study was to examine the natural history of and risk factors for MAC progression.

Methods

The MESA is a longitudinal cohort study of participants aged 45 to 84 years without clinical cardiovascular disease who underwent serial cardiac computed tomography studies with quantification of MAC. Regression models were used to identify risk factors associated with MAC incidence and progression.

Results

Prevalent MAC was observed in 534 (9%) of 5,895 participants. Over a median 2.3 years, 280 (5%) developed incident MAC. After adjustment, age was the strongest predictor of incident MAC (adjusted OR, 2.25 per 10 years; 95% CI, 1.97-2.58; P < .0001). Female gender, white ethnicity, body mass index, diabetes, hypertension, hyperlipidemia, serum cholesterol, smoking, and interleukin-6 were also significant predictors of incident MAC. In participants with prevalent MAC, the median rate of change was 10.1 [IQR, − 6.7 to 60.7] Agatston units (AU)/year. Baseline MAC severity was the predominant predictor of rate of MAC progression (β-coefficient per 10 AU, 0.88; 95% CI, 0.85-0.91; P < .0001), although ethnicity and smoking status possessed modest influence.

Conclusions

Several cardiovascular risk factors predicted incident MAC, as did female gender. Severity of baseline MAC was the primary predictor of MAC progression, suggesting that, while atherosclerotic processes may initiate MAC, they are only modestly associated with its progression over these time frames.

Section snippets

Study population and data collection

The Multi-Ethnic Study of Atherosclerosis (MESA) is a longitudinal cohort study of 6,814 community-dwelling men and women aged 45–84 years without evidence of clinical cardiovascular disease at baseline. Participants were recruited from 6 U.S. communities (Forsyth County, NC; Northern Manhattan and the Bronx, NY; Baltimore County, MD; St. Paul, MN; Chicago, IL; and Los Angeles County, CA). A description of the design of MESA has been published previously.11 Participants attended study visits

Baseline participant characteristics

Of the 6,814 participants within MESA, 5,895 underwent follow-up cardiac CT scans with assessment of MAC with a median between-scan interval of 2.3 [IQR 1.6, 3.1] years (Figure 1). The mean age was 62 ± 10 years and 46% were male. The cohort was ethnically diverse with 26% reported as black, 22% Hispanic, and 13% Chinese (Table I). Mitral annulus calcification was prevalent in 534 (9%) of participants at baseline, leaving 5,361 participants at risk for developing incident MAC.

Incident mitral annulus calcification

Of the 5,361

Discussion

Epidemiologic associations between prevalent MAC and cardiovascular risk factors support the hypothesis that MAC is a marker of atherosclerotic disease burden1, 7, 8, 9; however, the impact of atherosclerotic risk factors on MAC progression has never been addressed. The present analysis utilized the diverse MESA cohort in order to characterize the progression of MAC, specifically the development of incident MAC and the rate change in prevalent MAC. Using quantitative serial CT measurement of

Disclosures

Conflicts of interest: We have no relevant relationships with industry to report.

Acknowledgements

The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

References (34)

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