title: Cardiovascular risk factors and mitral annular calcification in type 2 diabetes.
abstract: OBJECTIVE
  Mitral annular calcification (MAC) is a degenerative process of the mitral annulus associated with cardiac disease and stroke. Although thought to be more prevalent in type 2 diabetes (T2DM), MAC remains poorly characterized in this population, due to confounding by renal and cardiac disease. Our goal was to study the risk factors for MAC in a sample of T2DM subjects without renal and cardiac disease.
  
  
  METHODS
  The Penn Diabetes Heart Study (PDHS) is a cross-sectional study of diabetic individuals without clinical cardiovascular or renal disease. We quantified and analyzed MAC Agatston scores in baseline cardiac CTs from 1753 individuals. Logistic and tobit regression were used to assess MAC's relationship with risk factors and coronary artery calcium (CAC).
  
  
  RESULTS
  MAC was present in 12.0% of subjects, with a median Agatston score of 72.3 [Interquartile range (22.2-256.9)]. Older age, female gender, Caucasian race, and longer diabetes duration were independently associated with both the presence and extent MAC even after controlling for CAC; however, hypertension, hyperlipidemia, tobacco use, CRP levels, and other comorbidities were not associated. CAC was strongly associated with MAC [OR of 4.0 (95% CI 2.4-6.6)] in multivariable models.
  
  
  CONCLUSIONS
  Age, female gender, Caucasian race, and diabetes duration were associated with the presence and extent of MAC in T2DM subjects, independent of CAC, which was also strongly associated with MAC. These data suggest that additional mechanisms for MAC formation in diabetics may exist which are distinct from those related to generalized atherosclerosis and deserve further investigation.
authors.affiliation: University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Atif N
authors.initials: AN
authors.lastname: Qasim
authors.forename: Hashmi
authors.initials: H
authors.lastname: Rafeek
authors.forename: Suraj P
authors.initials: SP
authors.lastname: Rasania
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Churchill
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferrari
authors.forename: Saurabh
authors.initials: S
authors.lastname: Jha
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Master
authors.forename: Claire K
authors.initials: CK
authors.lastname: Mulvey
authors.forename: Karen
authors.initials: K
authors.lastname: Terembula
authors.forename: Chris
authors.initials: C
authors.lastname: Dailing
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Muredach P
authors.initials: MP
authors.lastname: Reilly
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000150:complications*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D044465:White People