Cardiac and arterial calcifications and all-cause mortality in the elderly: The PROTEGER Study

ObjectiveTo investigate the association of overall mortality with the presence and extent of cardiovascular calcifications.MethodsWe investigated the association of cardiac (mitral annulus, aortic valve) and arterial calcifications (abdominal aorta, carotid and femoral arteries) by ultrasonography, with all-cause mortality in a population of 331 high-risk elderly subjects (86.8 ± 6.9 years). After a mean follow-up of 378 days, 110 deaths occurred.ResultsA simple calcification score, defined by the presence of cardiac and arterial calcifications, was significantly associated with all-cause mortality (HR = 1.47, 95% CI: 1.08–1.99), independent of low plasma albumin, increased plasma glucose and creatinine, as well as low diastolic blood pressure. Moreover, arterial calcifications showed negligible prognostic value with a high prevalence >89%, while cardiac calcifications significantly predicted overall mortality (HR = 1.92, 95% CI: 1.28–2.87) at a prevalence of 36%. In another Cox regression, mitral annular calcification was proved to be a significant predictor of total mortality (HR = 1.61, 95% CI: 1.02–2.54).ConclusionThe independent association between the extent of calcification and all-cause mortality is consistently significant in this frail elderly population. Arterial calcification presents a very high prevalence but a low predictive value, whereas in cardiac calcification, prevalence is lower but predictive value is much higher.