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

Objective: To investigate the association of overall mortality with the presence and extent of cardiovascular calcifications. Methods: We 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. Results: A 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). Conclusion: The 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. (C) 2010 Elsevier Ireland Ltd. All rights reserved.