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. 2018 Jun:273:45-52.
doi: 10.1016/j.atherosclerosis.2018.04.004. Epub 2018 Apr 6.

Resting heart rate and the incidence and progression of valvular calcium: The Multi-Ethnic Study of Atherosclerosis (MESA)

Kojo Amoakwa  1 , Oluwaseun E Fashanu  2 , Martin Tibuakuu  3 , Di Zhao  4 , Eliseo Guallar  4 , Seamus P Whelton  2 , Wesley T O'Neal  5 , Wendy S Post  4 , Matthew J Budoff  6 , Erin D Michos  7
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Resting heart rate and the incidence and progression of valvular calcium: The Multi-Ethnic Study of Atherosclerosis (MESA)

Kojo Amoakwa et al. Atherosclerosis. 2018 Jun.

Abstract

Background and aims: Left-sided valvular calcification is associated with cardiovascular disease (CVD) morbidity and mortality. Resting heart rate (RHR) may influence valvular calcium progression through shear stress. Whether RHR, an established CVD risk factor, is associated with valvular calcium progression is unknown. We assessed whether RHR predicts incidence and progression of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a community-based cohort free of CVD at baseline.

Methods: RHR was obtained from baseline electrocardiograms of 5498 MESA participants. MAC and AVC were quantified using Agatston scoring from cardiac computed tomography scans obtained at baseline and at a second examination during follow-up. We examined associations of RHR with incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker use.

Results: At baseline, participants had mean age of 62 ± 10 years and mean RHR of 63 ± 10 bpm; 12.3% and 8.9% had prevalent AVC and MAC, respectively. Over a median of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Risk Ratio 1.17 (95% CI 1.03-1.34)], but not incident AVC. However, RHR was associated with AVC progression [β = 1.62 (0.45-2.80) Agatston units/year for every 10 bpm increment], but not MAC progression.

Conclusions: Higher RHR was associated with MAC incidence and AVC progression, independent of traditional CVD risk factors. Future studies are needed to determine whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium incidence or progression.

Keywords: Aortic valve calcium; Cardiovascular; Computed tomography; Mitral annular calcium; Progression; Resting heart rate.

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Conflict of interest statement

Conflicts of interest

Dr. Michos has received an honorarium from Siemens Healthcare Diagnostics (unrelated to this topic). Dr. Budoff has received research funds from GE Healthcare. No other authors declare a conflict of interest.

Figures

Figure 1
Figure 1
A flow chart illustrating our exclusions, the prevalence of AVC and MAC at baseline, and the percentage of participants at risk who developed incident AVC/MAC on follow-up CT.
See this image and copyright information in PMC

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