Among a cohort of multiethnic participants without baseline cardiovascular disease, the presence of extracoronary calcification (ECC) at baseline was independently associated with an increased risk for heart failure (HF), especially HF with preserved ejection fraction (HFpEF), according to an analysis from the MESA study published March 26 in JACC: Heart Failure.

Sandeep Brar, MD, et al., examined outcomes in 6,809 participants (mean age, 62.5 years; 52.8% women) who had noncontrast cardiac CT scan for calcification of the aortic valve, aortic root, mitral valve and thoracic aorta. Of them, 53.1% had an ECC score of 0 and 46.9% an ECC score >0.

Results showed that over the mean 12.9 years of follow-up, there were 358 HF events, of which 179 were HF with reduced EF (HFrEF) and 135 were HFpEF. The unadjusted cumulative incidence of HF was significantly higher in those with vs. without ECC.

After adjusting for demographics and risk factors, there was a 1.7-fold greater risk of incident HF in the highest vs. the lowest quartile of ECC (adjusted hazard ratio [aHR], 1.72; p=0.007). Researchers found that when also adjusting for coronary artery calcification (CAC), this only reached borderline significance.

Looking at incident HFpEF, the risk was threefold higher in the highest vs. the lowest quartile of ECC (aHR, 3.09; p=0.003), remaining an independent risk factor after adjustment including CAC.

The authors note nearly half (47%) of participants had ECC at baseline, "demonstrating substantial ECC prevalence even among people free of cardiovascular disease." Furthermore, they write, high ECC remained predictive of HF among participants with low, intermediate and high 10-year HF risk on the basis of ARIC risk scores.

If the present findings are validated in other studies, the authors write that "ECC could help improve traditional risk factor estimation and clinical risk assessments for HF and HFpEF."