Calcium, phosphate and the risk of cardiovascular events and all-cause mortality in a population with stable coronary heart disease
ABSTRACT High serum calcium and phosphate levels have been linked to cardiovascular diseases and all-cause mortality but evidence from longitudinal studies is scarce, especially among patients with pre-existing coronary heart disease. The association between baseline calcium and phosphate and prognosis was examined in a cohort study of patients with stable coronary heart disease.
Serum calcium and phosphate were measured in a cohort of initially 1206 patients undergoing a 3 week rehabilitation programme after an acute cardiovascular event and subsequently being followed-up for 8 years. Multivariate Cox regression was employed to assess the association of quartiles and continuous levels of calcium and phosphate with secondary cardiovascular events and all-cause mortality.
No significant risk elevations were observed for secondary cardiovascular event incidence in models adjusted for a variety of potential confounders. High calcium levels, however, were strongly associated with mortality risk in adjusted models (HR(Q4vsQ1)=2.39 (1.22 to 4.66)). In additional multivariable analyses, the calcium/albumin ratio was predictive for all-cause mortality (HR(Q4vsQ1)=2.66 (1.35 to 5.22)) and marginally predictive for cardiovascular event incidence (HR(Q4vsQ1)=1.74 (1.00 to 3.05)).
Calcium and the ratio of calcium with albumin, its major binding protein, were strongly associated with all-cause mortality among patients with coronary heart disease. The underlying mechanisms and the clinical implications of these findings deserve further study.
- Heart (British Cardiac Society) 09/2012; 99(5). DOI:10.1136/heartjnl-2012-302480 · 6.02 Impact Factor
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ABSTRACT: Non-traditional risk factors substantially contribute to cardiovascular (CV) disease. A deranged calcium-phosphate metabolism-first identified as a major non-traditional CV risk factor in patients with chronic kidney disease-may be implicated in development and progression of CV disease even among individuals with intact renal function. This review thus summarizes epidemiological and experimental data on the role of calcium, phosphate, and its major regulating hormones-parathyroid hormone, calcitriol, and fibroblast growth factor 23-in CV medicine.European Heart Journal 10/2012; 34(15). DOI:10.1093/eurheartj/ehs353 · 14.72 Impact Factor
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ABSTRACT: OBJECTIVE: We have examined the association between serum phosphate and alkaline phosphatase (ALP) with incident cardiovascular disease (CVD) outcomes and total mortality in older men.Approach and Results-A prospective study of 3381 men, aged 60 to 79 years, without a history of myocardial infarction or stroke followed up for an average 11 years during which there were 605 major CVD events (fatal coronary heart disease and nonfatal myocardial infarction, stroke, and CVD death) and 984 total deaths. ALP but not serum phosphate was associated with increased risk of coronary heart disease and overall CVD events which persisted after adjustment for CVD risk factors and markers of inflammation and after exclusion of men with chronic kidney disease (adjusted hazard ratio per SD, 1.19 [1.05, 1.34]; P=0.007 and 1.10 [1.01, 1.21]; P=0.04). In contrast, serum phosphate was only associated with increased CVD mortality owing to noncoronary heart disease or stroke causes (adjusted hazard ratio per SD, 1.35 [1.01, 1.83]; P=0.04). Both raised phosphate and ALP were associated with significantly increased total mortality after full adjustment and exclusion of men with chronic kidney disease. CONCLUSIONS: ALP but not serum phosphate is associated with coronary heart disease risk in elderly men. High levels of ALP and serum phosphate are both associated with increased total mortality.Arteriosclerosis Thrombosis and Vascular Biology 02/2013; 33(5). DOI:10.1161/ATVBAHA.112.300826 · 5.53 Impact Factor