Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease

The strong heart study

Jorge Kizer, David O. Wiebers, Jack P. Whisnant, James M. Galloway, Thomas K. Welty, Elisa T. Lee, Lyle G. Best, Helaine E. Resnick, Mary J. Roman, Richard B. Devereux

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Background and Purpose - Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort. Methods - Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods. Results - During a median follow-up of 7 years, 86 strokes occurred. Age- and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95% CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95% CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95% CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95% CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses (P=0.698). Crossing of the survival curves precluded multivariable analysis using Cox models. Conclusions - In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation.

Original languageEnglish (US)
Pages (from-to)2533-2537
Number of pages5
JournalStroke
Volume36
Issue number12
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Sclerosis
Cardiovascular Diseases
Stroke
North American Indians
Aortic Valve
Calcification of Aortic Valve
Left Ventricular Hypertrophy
Proportional Hazards Models
C-Reactive Protein
Fibrinogen
Cohort Studies
Incidence
Population

Keywords

  • Calcium
  • Echocardiography
  • Heart valves
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease : The strong heart study. / Kizer, Jorge; Wiebers, David O.; Whisnant, Jack P.; Galloway, James M.; Welty, Thomas K.; Lee, Elisa T.; Best, Lyle G.; Resnick, Helaine E.; Roman, Mary J.; Devereux, Richard B.

In: Stroke, Vol. 36, No. 12, 12.2005, p. 2533-2537.

Research output: Contribution to journalArticle

Kizer, J, Wiebers, DO, Whisnant, JP, Galloway, JM, Welty, TK, Lee, ET, Best, LG, Resnick, HE, Roman, MJ & Devereux, RB 2005, 'Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: The strong heart study', Stroke, vol. 36, no. 12, pp. 2533-2537. https://doi.org/10.1161/01.STR.0000190005.09442.ad
Kizer, Jorge ; Wiebers, David O. ; Whisnant, Jack P. ; Galloway, James M. ; Welty, Thomas K. ; Lee, Elisa T. ; Best, Lyle G. ; Resnick, Helaine E. ; Roman, Mary J. ; Devereux, Richard B. / Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease : The strong heart study. In: Stroke. 2005 ; Vol. 36, No. 12. pp. 2533-2537.
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abstract = "Background and Purpose - Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort. Methods - Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods. Results - During a median follow-up of 7 years, 86 strokes occurred. Age- and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95{\%} CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95{\%} CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95{\%} CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95{\%} CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses (P=0.698). Crossing of the survival curves precluded multivariable analysis using Cox models. Conclusions - In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation.",
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T1 - Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease

T2 - The strong heart study

AU - Kizer, Jorge

AU - Wiebers, David O.

AU - Whisnant, Jack P.

AU - Galloway, James M.

AU - Welty, Thomas K.

AU - Lee, Elisa T.

AU - Best, Lyle G.

AU - Resnick, Helaine E.

AU - Roman, Mary J.

AU - Devereux, Richard B.

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Y1 - 2005/12

N2 - Background and Purpose - Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort. Methods - Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods. Results - During a median follow-up of 7 years, 86 strokes occurred. Age- and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95% CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95% CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95% CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95% CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses (P=0.698). Crossing of the survival curves precluded multivariable analysis using Cox models. Conclusions - In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation.

AB - Background and Purpose - Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort. Methods - Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods. Results - During a median follow-up of 7 years, 86 strokes occurred. Age- and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95% CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95% CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95% CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95% CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses (P=0.698). Crossing of the survival curves precluded multivariable analysis using Cox models. Conclusions - In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation.

KW - Calcium

KW - Echocardiography

KW - Heart valves

KW - Stroke

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