title: Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: the Strong Heart Study.
abstract: OBJECTIVE
  Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort.
  
  
  METHODS
  Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods.
  
  
  RESULTS
  During a median follow-up of 7 years, 86 strokes occurred. Age- and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95% CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95% CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95% CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95% CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses (P=0.698). Crossing of the survival curves precluded multivariable analysis using Cox models.
  
  
  CONCLUSIONS
  In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation.
authors.affiliation: Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA. jok2007@med.cornell.edu
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Kizer
authors.forename: David O
authors.initials: DO
authors.lastname: Wiebers
authors.forename: Jack P
authors.initials: JP
authors.lastname: Whisnant
authors.forename: James M
authors.initials: JM
authors.lastname: Galloway
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Welty
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D020521:Stroke / Q000145:classification / Q000453:epidemiology* / Q000517:prevention & control*