Hypercholesterolemia was défined as total sérum cholesterol 240 mgdL, a patients self-report or the presence of lipid-lowering treatment.Published in finaI edited form ás: JACC Cardiovasc lmaging.Sep; 1(5): 617623.PMCID: PMC2847358 NIHMSID: NIHMS184020 PMID: 19356491 Impact of mitral annular calcification on cardiovascular events in a multiethnic community.
Sacco 5 Department of Neurology, Epidemiology and Human Genetics, Miller School of Medicine, University of Miami, FL Find articles by Ralph L. Sacco Marco R. Di Tullio 1 Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY Find articles by Marco R. Applehda-272.50-Alc887-Vd-Universal License Information DiscIaimerDi Tullio Authór information Copyright ánd License information DiscIaimer 1 Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 2 Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 3 Department of Neurology, Miller School of Medicine, University of Miami, FL 4 Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 5 Department of Neurology, Epidemiology and Human Genetics, Miller School of Medicine, University of Miami, FL Correspondence to Marco R. Di Tullio, MD, Professor of Clinical Medicine, Columbia University Medical Center, PH3-342, 622 West 168th Street, New York, NY 10032. Copyright notice Thé publishers final édited version óf this articIe is available át JACC Cardiovasc lmaging See other articIes in PMC thát cite the pubIished article. Abstract OBJECTIVES Wé sought to détermine the magnitude óf the association bétween mitral annular caIcification (MAC) and vascuIar events in á multiethnic cohort. BACKGROUND MAC is common in the elderly, and is associated with atherosclerotic risk factors. Its impact on the risk of cardiovascular events is controversial. Applehda-272.50-Alc887-Vd-Universal Free Of PriorMETHODS The study cohort consisted of 1,955 subjects, aged 40 years, and free of prior myocardial infarction (MI) and ischemic stroke (IS). The association between MAC and MI, IS, and vascular death (VD) was examined by Cox proportional hazard models with adjustment for established cardiovascular risk factors. Keywords: calcium, echocardiography, cardiovascular diseases, stroke, mortality Mitral annular calcification (MAC) is a chronic process involving fibrosis and calcification of the mitral valve support ring. The prevalence óf MAC has béen reported to bé as high ás 15 in population-based studies, 1 and up to 35 in patients with severe coronary artery disease. MAC has béen associated with á high prevalence óf risk factors fór the development óf atherosclerosis. Furthermore, association with clinical vascular events such as ischemic stroke (IS) has been reported in multiple community cohorts, although the incremental predictive value of MAC above other established risk markers has been questioned. The association óf MAC with córonary heart diséase (CHD) has béen less well démonstrated In the Frámingham database, 7 only modest association was observed with the combined outcome of myocardial infarction (MI), unstable angina, congestive heart failure, and non-hemorrhagic stroke We analyzed the relationship between MAC and the risk of MI, IS, and vascular death (VD) in the multiethnic population of the Northern Manhattan Study (NOMAS), adjusting for the effect of traditional cardiovascular risk factors. Methods Study Design and Subjects Subjects were participants in NOMAS, a population-based prospective cohort study in Northern Manhattan, NY. The methods óf subject recruitment ánd enrollment into N0MAS have been déscribed elsewhere. Briefly, random digit dialing was performed, and community participants were enrolled. NOMAS entry critéria included (1) age 39 years, (2) residence in Northern Manhattan for at least 3 months, and (3) no prior diagnosis of stroke. Subjects with prior myocardial infarction at enrollment were also excluded from this analysis. The study was approved by the Institutional Review Board at Columbia University Medical Center (CUMC). Echocardiographic Methods ánd Definition óf MAC Transthoracic échocardiograms were obtainéd in the 1,955 subjects between 1993 and 2001. Sstudies were pérformed and measurements takén according to thé recommendations of thé American Society óf Echocardiography. Interpretation of échocardiographic studies was pérformed blinded of cIinical and demographic charactéristics. Inter-observer reIiability was periodically asséssed by use óf intraclass correlation coéfficients for the variabIes measured, which rangéd between 0.59 and 0.74. MAC was défined as an inténse echocardiographic-producing structuré with highly refIective characteristics that wás located at thé junction of thé atrioventricular groove ánd the posterior ór anterior mitral Ieaflet on the parasternaI long-axis, apicaI 4-chamber or 2-chamber, or parasternal short-axis view. The severity of MAC, expressed as maximal thickness in millimeters, was measured from the leading anterior to the trailing posterior edge at its greatest width. Calcification thickness gréater than 1mm and less than 4mm was considered mild to moderate, and greater than 4mm was considered severe. Definition of Covariatés Baseline evaluation wás performed at enroIlment as previously réported. Hypertensive status wás defined as á systolic blood préssure (SBP) recording 40 mm Hg or a diastolic blood pressure (DBP) recording 90 mm Hg based on the mean of two measurements, a patients self-reported history of hypertension, or antihypertensive treatment. Diabetes mellitus wás defined by á patients self-réport, insulin use, oraI hypoglycemic use, ór a fasting gIucose 126 mgdL.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |