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Journal of the American Heart Association · 2026

Regulators of Mineralization and Long-Term Progression of Aortic Valve and Mitral Annular Calcification: MESA.

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Bortnick Anna E, Naveed Mahim, Fu Xueyan, Shea Kyla, Kestenbaum Bryan, de Boer Ian, Ix Joachim H, Kim Ryung, Hamerton Emily, Kankaria Rohan, Tracy Russell P, Tsai Michael, Budoff Matthew, Thanassoulis George, Booth Sarah, Kizer Jorge R

Аннотация

BACKGROUND: Aortic valve calcification (AVC) and mitral annual calcification (MAC) may progress to aortic and mitral stenosis in older adults. The role of major mineralization regulators MGP (matrix Gla protein), FGF-23 (fibroblast growth factor-23), and fetuin-A in long-term progression of AVC and MAC remains unexamined.

METHODS: We measured blood levels of dp-ucMGP (n=2663) at study baseline and evaluated these concurrently with prior baseline measures of FGF-23 (n=6547) and fetuin-A (n=2550) in relation to AVC and MAC quantified on ≤3 serial computed tomography scans over 9.4 (interquartile range, 9.0-9.8) years in MESA (Multi-Ethnic Study of Atherosclerosis). We used linear mixed-effects models to simultaneously assess the incidence and progression of AVC and MAC.

RESULTS: Our objective was to investigate the association of circulating dephosphorylated-uncarboxylated (dp-uc) MGP, reflecting vitamin K deficiency/diminished MGP anticalcific capacity; FGF-23, a phosphaturic hormone; and fetuin-A, a calcium-phosphate solubilizer, with long-term incidence and progression of AVC and MAC. After adjustment for demographic and clinical characteristics, dp-ucMGP was associated with higher annual incidence/progression of AVC (0.94 [95% CI, 0.42, 1.46] Agatston units/y) and MAC (3.90 [95% CI, 1.06, 6.74] Agatston units/y); FGF-23 with higher annual incidence/progression of MAC (2.61 [95% CI, 0.50, 4.72] Agatston units/y); and fetuin-A with lower annual incidence/progression of AVC (-0.89 [95% CI, -1.55, -0.23] Agatston units/y (all per SD increment in regulator).

CONCLUSIONS: In this multiethnic sample, dp-ucMGP and FGF-23 were associated with higher, and fetuin-A with lower, long-term incidence/progression of valvular or annular calcification. This has implications for therapeutic trials of calcific valvular disease, particularly targeting vitamin K supplementation to individuals with higher dp-ucMGP levels.

ИП Урсолов Владлен Сергеевич

ИНН 500118482352 · ОГРНИП 314500117700049

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