Mitral Annular Calcification and the Risk of Stroke

To the Editor: I enjoyed reading the excellent article by Benjamin et al. (Aug. 6 issue)¹ on the relation of mitral annular calcification (MAC) to the occurrence of stroke in an elderly cohort of the Framingham Study. However, I would like to raise some issues of concern. First, the authors state that isolated transient ischemic attacks were included among the cerebrovascular events in a separate analysis, but they also state that they excluded from the study population subjects with mitral stenosis, a mitral-valve prosthesis, or a history of stroke (at or before the index examination). Since transient ischemic attacks are…