Mitral annulus calcification - a window to diffuse atherosclerosis of the vascular system

Mitral annulus calcification (MAC) is a chronic, non-inflammatory, degenera tive process of the fibrous support structure of the mitral valve. It occur s more often in women and the elderly. MAC is associated with known atheros clerotic risk factors such as diabetes mellitus, hypertension and hyperchol esterolemia. It is also known that patient with MAC have higher prevalence of left atrial and left ventricular enlargement, hypertrophic cardiomyopath y, atrial fibrillation, aortic valve calcification and stenosis, various ca rdiac conduction defects, bacterial endocarditis, cardiovascular events and stroke, though the etiological basis is unknown. Pathological studies from the 80s present a theory that MAC is a form of atherosclerosis. In order t o test this theory we conducted during the last years a few clinical studie s to examine the association of MAC and known atherosclerotic phenomena. We found higher prevalence of aortic atheroma in patients with MAC and athero ma thickness. We also found in MAC patients higher prevalence of carotid ar tery stenosis, coronary artery stenosis, peripheral artery stenosis and hig her levels of beta2-Glycoprotein I antibodies in patients with MAC thicknes s equal or greater than 5 mm. These studies support the theory that MAC is a form of atherosclerosis and define a group of patients with higher preval ence of atherosclerotic disease in multiple blood vessels. The purpose of t his review is to summarize the data concerning MAC and atherosclerotic proc esses, emphasizing that MAC in itself may be an atherosclerotic process. (C ) 2001 Elsevier Science Ireland Ltd. All rights reserved.