title: Risk factors associated with the incidence and progression of mitral annulus calcification: the multi-ethnic study of atherosclerosis.
abstract: 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.
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Clinical Research Institute, Boston, MA. Electronic address: elmariah@gmail.com.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Joseph A C
authors.initials: JA
authors.lastname: Delaney
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Hamirani
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.forename: Kevin D
authors.initials: KD
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D015331:Cohort Studies; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D015995:Prevalence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed