Clinical Investigation
Acute Ischemic Heart Disease
Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly. The Cardiovascular Health Study (CHS)

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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.

Section snippets

Participant population

The CHS is an observational cohort study designed to assess risk factors and cardiovascular disease outcomes in elderly persons. Participants aged ≥65 were sampled from Medicare enrollment lists in 4 US communities. Of 5888 participants (age, 65-100 at study entry) enrolled in the study, 5201 were recruited in 1989 to 1990, and a supplemental cohort of 687 African-American participants were added in 1992 to 1993. Persons were excluded from the CHS if they were wheel-chair bound or

Characteristics of the subjects and prevalence of valvular calcification

The mean age of the participants was 76 ± 5 years, 60% were women, 83.4% were white, 16.2% were African American, and 0.5% were recorded as “other” race. Mitral annular calcification was found in 1640 (42%) participants, AAC in 1710 (44%), AVS in 2114 (54%), and all 3 were present together in 662 participants (17%). Combined MAC and AAC were found in 25% of participants, MAC and AVS in 26%, and AAC combined with AVS in 28% of the subjects (Figure 1). Participants with MAC or AAC and/or AVS were

Discussion

In this large cohort of free-living elderly individuals, MAC, AAC, AVS, and their combination were highly prevalent and associated with advancing age as well as with CVD independently of age and sex. However, the strength of association between these 3 forms of ectopic valvular calcification with CVD varied, MAC having the strongest relationship with CVD.

The high prevalence of calcified mitral annulus and AVS, and their relationship to age in the present study are consistent with prior clinical

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    Supported by NHLBI contracts NO1-HC-85079-85086 and NO1-HC-15103.

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