TY - JOUR
T1 - Mitral annular calcification as a predictor of stroke in the multiethnic study of atherosclerosis
AU - Onuegbu, Afiachukwu
AU - Calicchio, Francesca
AU - Kinninger, April
AU - Nakanishi, Rine
AU - Carr, John J.
AU - Nasir, Khurram
AU - Gottesman, Rebecca
AU - Budoff, Matthew
N1 - Funding Information:
The current research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS).
Publisher Copyright:
© 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - BACKGROUND: Mitral annular calcification (MAC) is associated with an increased risk for cardiovascular morbidity and mortality. This study provides recent data on the association between cardiac computed tomography (CT) derived MAC and 15 years of stroke risk in a racially diverse cohort.METHODS: All multiethnic studies of atherosclerosis participants ( n = 6814) who completed a cardiac CT at baseline were included in this analysis. MAC score was calculated from cardiac CT using the Agatston and volume score methods. Multivariable Cox proportional hazard regression models were used to compute hazard ratios for the association between MAC and stroke after adjusting for traditional cardiovascular risk factors, inflammatory markers, coronary artery calcium score, atrial fibrillation, and left atrial size.RESULTS: Overall, 9% of participants (644/6814) had MAC at baseline. Over a surveillance period of 15 years, 304 strokes occurred, and 79% were ischemic strokes. After adjusting for age, sex, race/ethnicity, SBP, diabetes, smoking, fibrinogen, IL-6, high-sensitivity C-reactive protein, and coronary artery calcium score, baseline MAC was associated with increased risk for all strokes [hazard ratio 1.68; 95% confidence interval (CI) 1.22-2.30: P = 0.0013]. When atrial fibrillation/flutter and left atrial size were included in the final multivariable model, MAC remained a predictor of all strokes (hazard ratio 1.93; 95% CI 1.22-3.05: P < 0.0051) and ischemic stroke (hazard ratio 2.03; 95% CI 1.24-3.31: P < 0.0046).CONCLUSION: MAC is an independent predictor of long-term stroke risk in a racially diverse population beyond conventional cardiovascular risk factors and atrial fibrillation.
AB - BACKGROUND: Mitral annular calcification (MAC) is associated with an increased risk for cardiovascular morbidity and mortality. This study provides recent data on the association between cardiac computed tomography (CT) derived MAC and 15 years of stroke risk in a racially diverse cohort.METHODS: All multiethnic studies of atherosclerosis participants ( n = 6814) who completed a cardiac CT at baseline were included in this analysis. MAC score was calculated from cardiac CT using the Agatston and volume score methods. Multivariable Cox proportional hazard regression models were used to compute hazard ratios for the association between MAC and stroke after adjusting for traditional cardiovascular risk factors, inflammatory markers, coronary artery calcium score, atrial fibrillation, and left atrial size.RESULTS: Overall, 9% of participants (644/6814) had MAC at baseline. Over a surveillance period of 15 years, 304 strokes occurred, and 79% were ischemic strokes. After adjusting for age, sex, race/ethnicity, SBP, diabetes, smoking, fibrinogen, IL-6, high-sensitivity C-reactive protein, and coronary artery calcium score, baseline MAC was associated with increased risk for all strokes [hazard ratio 1.68; 95% confidence interval (CI) 1.22-2.30: P = 0.0013]. When atrial fibrillation/flutter and left atrial size were included in the final multivariable model, MAC remained a predictor of all strokes (hazard ratio 1.93; 95% CI 1.22-3.05: P < 0.0051) and ischemic stroke (hazard ratio 2.03; 95% CI 1.24-3.31: P < 0.0046).CONCLUSION: MAC is an independent predictor of long-term stroke risk in a racially diverse population beyond conventional cardiovascular risk factors and atrial fibrillation.
KW - cardiac computed tomography
KW - coronary artery calcium score
KW - mitral annular calcification
KW - multiethnic study of atherosclerosis
KW - stroke and cardiovascular disease
KW - Calcium
KW - Humans
KW - Risk Factors
KW - Stroke/etiology
KW - Atherosclerosis/complications
KW - Heart Valve Diseases/complications
KW - Calcinosis/complications
KW - Atrial Fibrillation/complications
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U2 - 10.2459/JCM.0000000000001524
DO - 10.2459/JCM.0000000000001524
M3 - Article
C2 - 37409651
AN - SCOPUS:85168428004
SN - 1558-2027
VL - 24
SP - 680
EP - 688
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
IS - 9
ER -