Accumulation of calcium and phosphorus in the mitral valve in comparison with the abdominal aorta and the scaphoid bone

Calcification of Cardiac Valves in Metabolic Bone Disease: An Updated Review of Clinical Studies

Epidemiological and clinical data have suggested the existence of a relationship between cardiovascular diseases and metabolic bone disease. Several studies have demonstrated that heart valve calcification presents substantial similarities with that of bone. Literature data indicate that there are many active processes which promote osteogenesis and loss of mineralization inhibitors that lead to the deposition of extracellular matrix and proteins of bone tissue in cardiac valves. This review aimed to synthesize the available data in order to allow a better understanding of the relationship between osteoporosis or other metabolic bone diseases, such as primary hyperparathyroidism, and valvular calcification in humans. Electronic databases of Pubmed-Medline, Cochrane Library, and SCOPUS from inception to March 31, 2019 were searched. The full set of the articles potentially eligible were carefully assessed and reviewed. Finally, 23 studies were eligible and included in the systematic review. The majority of studies reported that osteoporosis and/or osteopenia were independent risk factors for valvular calcifications, even after adjusting for common cardiovascular risk factors. This suggests that this relationship is not only due to the presence of common cardiovascular risk factors but rather to underlying biological factors that connect them. Instead, regarding the association between primary hyperparathyroidism and valve calcification, conflicting data were found in the literature. To sum up, most of the literature data confirm that cardiac valve calcification processes are strongly influenced by alterations in bone metabolism. In particular, the patients with osteoporosis or primary hyperparathyroidism have an acceleration in the process of valvular calcification. Additional studies are needed to specifically address the mechanisms by which metabolic bone diseases could influence cardiac valve calcification.

Cardiovascular risk factors and mitral annular calcification in type 2 diabetes

OBJECTIVE

Mitral annular calcification (MAC) is a degenerative process of the mitral annulus associated with cardiac disease and stroke. Although thought to be more prevalent in type 2 diabetes (T2DM), MAC remains poorly characterized in this population, due to confounding by renal and cardiac disease. Our goal was to study the risk factors for MAC in a sample of T2DM subjects without renal and cardiac disease.

METHODS

The Penn Diabetes Heart Study (PDHS) is a cross-sectional study of diabetic individuals without clinical cardiovascular or renal disease. We quantified and analyzed MAC Agatston scores in baseline cardiac CTs from 1753 individuals. Logistic and tobit regression were used to assess MAC's relationship with risk factors and coronary artery calcium (CAC).

RESULTS

MAC was present in 12.0% of subjects, with a median Agatston score of 72.3 [Interquartile range (22.2-256.9)]. Older age, female gender, Caucasian race, and longer diabetes duration were independently associated with both the presence and extent MAC even after controlling for CAC; however, hypertension, hyperlipidemia, tobacco use, CRP levels, and other comorbidities were not associated. CAC was strongly associated with MAC [OR of 4.0 (95% CI 2.4-6.6)] in multivariable models.

CONCLUSIONS

Age, female gender, Caucasian race, and diabetes duration were associated with the presence and extent of MAC in T2DM subjects, independent of CAC, which was also strongly associated with MAC. These data suggest that additional mechanisms for MAC formation in diabetics may exist which are distinct from those related to generalized atherosclerosis and deserve further investigation.

Relationship between renal stone formation, mitral annular calcification and bone resorption markers

BACKGROUND AND OBJECTIVES

Mitral annular calcification (MAC) is associated with osteoporosis and there is evidence of reduced bone mineral density (BMD) in patients with renal stone formation (RSF). Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption.

METHODS

Fifty-nine patients (mean age, 41.5 years) with RSF and 40 healthy subjects (mean age, 44.2 years) underwent screening for MAC and BMD, and measurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline.

RESULTS

MAC was diagnosed in 11 (18%) patients with RSF compared with 1 (2.5%) control (P=.01). Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower (P<.001, P=.02, P<.001, P<.001 and P<.001, respectively), but serum alkaline phosphatase, calcium and potassium levels were higher (P=.008, P=.007 and P=.001, respectively) in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative (more osteopenic) in patients and subjects with MAC than in those without MAC (P=.01 and P=.004, respectively). In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC (P=.03 and P=.04, respectively).

CONCLUSIONS

Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies.

Prevalence and clinical correlates of mitral annulus calcification in Hispanics and non-Hispanic whites

BACKGROUND

Data about mitral annulus calcification (MAC) are sparse in Hispanics. We compare prevalence and clinical correlates of MAC in Hispanics and non-Hispanic whites.

METHODS

We reviewed echocardiograms and clinical data of 337 Hispanics and 279 non-Hispanic whites, age 45 to 75 years. In cross-sectional data, prevalence and interrelationships of MAC, coronary heart disease (CHD), and risk factors were compared using multivariable logistic regression.

RESULTS

In Hispanics, MAC was significantly associated with CHD (odds ratio [OR] = 2.06, confidence interval [CI] = 1.09-3.87), age (OR = 1.73, CI = 1.21-2.49), female sex (OR = 1.87, CI = 1.01-3.47), smoking (OR = 1.80, CI = 1.01-3.24), and having multiple (>2) risk factors (OR = 3.43, CI = 2.66-4.43). In non-Hispanic whites, MAC was associated with CHD (OR = 4.24, CI = 2.00-8.98), age (OR = 2.87, CI = 1.82-4.50), and having multiple risk factors (OR = 3.59, CI = 2.7-4.77). There were no significant ethnic differences in prevalence of MAC.

CONCLUSIONS

Among Hispanics referred for echocardiography, MAC is associated with CHD and risk factors.

Mitral annular calcification is associated with osteoporosis in women

BACKGROUND

Few studies have suggested association between mitral annular calcification (MAC) and osteoporosis in women who are post-menopausal. However, the association of MAC with osteoporosis in women, in relation to bone resorption, as assessed by using the dual-energy x-ray absorptiometry method (DEXA), have not been performed. We sought to examine the association between MAC and osteoporosis.

METHODS

In this prospective, observational study carried out in a tertiary referral center, 340 women (mean age +/- SD, 56 +/- 10 years; age range, 33-85 years) underwent echocardiography, with specific assessment of MAC and bone mineral density measurement (T-scores) using DEXA.

RESULTS

MAC was absent in 123 patients (group I) and present in 217 patients (group II). Compared with the control group, the group with MAC had a significantly higher prevalence and severity of osteoporosis (18.2% vs 55.5%, P <.001). Severe osteoporosis was significantly more common in the severe MAC subgroup (n = 66) than in the control subjects (65.2% vs 17.1%; Pearson chi2, 70.02; df = 4; P <.001). With multivariate analysis, only T-scores and age were highly predictive of MAC, with an odds ratio of 2.66 (95 % CI, 1.85-3.83) and 1.04 (95% CI, 1.01-1.07), respectively.

CONCLUSIONS

MAC is associated with osteoporosis. Bone mineral density measurement (T-scores) and age were highly predictive of MAC in women.