title: Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly. The Cardiovascular Health Study (CHS).
abstract: BACKGROUND
  Mitral annular calcification (MAC), aortic annular calcification (AAC), and aortic valve sclerosis (AVS) are associated with aging, and MAC and AVS are markers of advanced atherosclerosis. No studies have examined the prevalence and the clinical relevance of all 3 forms of calcification in a single free-living elderly population.
  
  
  METHODS
  We used 2-dimensional echocardiography to evaluate MAC, AAC, AVS and all 3 combined in 3929 participants, mean age 76 +/- 5 years, 60% women, in the Cardiovascular Health Study, a prospective community-based observational study designed to assess cardiovascular disease (CVD) risk factors and outcomes in elderly persons.
  
  
  RESULTS
  Mitral annular calcification was found in 1640 (42 %) subjects, AAC in 1710 (44 %), AVS in 2114 (54 %), and all 3 combined in 662 (17 %). The participants with these findings were older than those without them, and those with MAC had worse cardiovascular, renal, metabolic, and functional profile than those with AAC and AVS. Age-, sex-, and race-adjusted logistic regression analysis found a significant association between the 3 calcification categories and CVD, the strongest being between the combined group with congestive heart failure (odds ratio 2.04, 95% CI 1.34-3.09). In highly adjusted models, only MAC was associated with CVD, and the strength of association was related to the severity of MAC.
  
  
  CONCLUSIONS
  In free-living elderly, MAC, AAC, and AVS are highly prevalent and are associated with CVD. Mitral annular calcification in particular has strong association with CVD, and with an adverse biomedical profile.
authors.affiliation: Department of Research and Education, St Francis Hospital, SUNY at Stony Brook, Roslyn, NY, USA.
authors.forename: Eddy
authors.initials: E
authors.lastname: Barasch
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
authors.forename: Emily K Marino
authors.initials: EK
authors.lastname: Larsen
authors.forename: Paulo H M
authors.initials: PH
authors.lastname: Chaves
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012598:Sclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D014463:Ultrasonography