title: Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study.
abstract: 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.
  
  
  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.
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass 01702-5827, USA.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000328:Adult; D002114:Calcinosis / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D012307:Risk Factors; D014463:Ultrasonography