Mitral annular calcification predicts cardiovascular morbidity and mortality: The Framingham Heart Study

Caroline S. Fox, Ramachandran S. Vasan, Helen Parise, Daniel Levy, Christopher J. O'Donnell, Ralph B. D'Agostino, Emelia J. Benjamin

Research output: Contribution to journalArticlepeer-review

381 Scopus citations


Background - Mitral annular calcification (MAC) has been associated with stroke in longitudinal, community-based cohorts and cardiovascular disease (CVD) outcomes in many small retrospective studies. Prospective data are limited on the relation of MAC with CVD morbidity and mortality. 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 1979 and 1981. Cox proportional hazards models were used to estimate hazard ratios (HRs) associated with the presence of MAC for each outcome. Of 1197(445 male, 752 female) subjects who had adequate echocardiographic assessment, 14% had MAC. There were 307 incident CVD events and 621 deaths. 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). For each 1-mm increase in MAC, the risk of incident CVD, CVD death, and all-cause death increased by ≈ 10%. Conclusions - The independent association of MAC with incident CVD and CVD death underscores that cardiac calcification is a marker of increased CVD risk.

Original languageEnglish (US)
Pages (from-to)1492-1496
Number of pages5
Issue number11
StatePublished - Mar 25 2003
Externally publishedYes


  • Calcium
  • Cardiovascular diseases
  • Echocardiography
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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