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15–18 Other valvular calcification measurements, including aortic sclerosis and aortic stenosis, have been shown to be manifestations of subclinical CVD by virtue of their association with CVD risk factors 19 and with an increased risk of CVD events, including coronary artery disease, 8 stroke, 20 and CVD death.

Subclinical cardiovascular disease (CVD) measurements have been demonstrated to have the same risk factors as clinically overt CVD 14 and to be predictive of incident CVD events. In a prior prospective investigation from the Framingham Heart Study, MAC was independently associated with stroke. Since then, it has been associated with endocarditis, 4 coronary artery disease, 5–9 and congestive heart failure 10–12 in several studies, which mostly have been small and retrospective in design. 1,2 It was first described in 1908 by Bonninger 3 in its association with complete heart block. Mitral annular calcification (MAC) is a fibrous, degenerative calcification of the mitral valve support ring. For each 1-mm increase in MAC, the risk of incident CVD, CVD death, and all-cause death increased by ≈10%.Ĭonclusions- The independent association of MAC with incident CVD and CVD death underscores that cardiac calcification is a marker of increased CVD risk. In multivariable adjusted analyses, MAC was associated with an increased risk of incident CVD (HR, 1.5 95% CI, 1.1, 2.0), CVD death (HR, 1.6 95% CI, 1.1, 2.3), and all-cause death (HR, 1.3 95% CI, 1.04, 1.6). There were 307 incident CVD events and 621 deaths. Of 1197(445 male, 752 female) subjects who had adequate echocardiographic assessment, 14% had MAC.

Cox proportional hazards models were used to estimate hazard ratios (HRs) associated with the presence of MAC for each outcome. Methods and Results- We examined the association between MAC assessed by M-mode echocardiography and the incidence of CVD, CVD death, and all-cause death over 16 years of follow-up in the Framingham Heart Study subjects who attended a routine examination between 19. Prospective data are limited on the relation of MAC with CVD morbidity and mortality.