Foley Robert N, Collins Allan J, Ishani Areef, Kalra Philip A
United States Renal Data System, Minneapolis, MN 55404, USA.
Am Heart J. 2008 Sep;156(3):556-63. doi: 10.1016/j.ahj.2008.05.016.
Calcium-phosphate levels, linked to vascular dysfunction in chronic kidney disease, may represent novel risk factors for coronary heart disease, stroke, and death in community-dwelling adults.
We tested this hypothesis over 12.6 years of follow-up in the prospective, community-based Atherosclerosis Risk in Communities Study (n = 15,732).
At baseline, mean (SD) values were 9.8 (0.4) mg/dL for serum calcium, 3.4 (0.5) mg/dL for serum phosphate, 33.6 (5.3) mg(2)/dL(2) for calcium-phosphate product, 54.2 (5.7) years for age, and 93.1 (21.5) mL/min per 1.73 m(2) for glomerular filtration rate (GFR). Shared associations of calcium, phosphate, and calcium-phosphate product included older age, female sex, African American race, cigarette-years, current cigarette smoking, low body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, low serum albumin, low GFR, low caloric intake, and phosphorus intake. With adjustment for age, demographic characteristics, comorbid conditions, albumin, and GFR, calcium-associated hazards ratios for coronary heart disease, stroke, and death were, respectively, 1.01 (95% confidence interval 0.96-1.06), 1.16 (1.07-1.26, P = .0005), and 1.03 (0.98-1.08); phosphate-associated hazards ratios were 1.03 (0.98-1.08), 1.11 (1.02-1.21, P = .0219), and 1.14 (1.09-1.20, P < .0001); calcium-phosphate product-associated hazards ratios were 1.03 (0.98-1.08), 1.15 (1.05-1.26, P = .0017), and 1.15 (1.09-1.20, P < .0001).
Although calcium, phosphate, and calcium-phosphate product levels exhibit complex associations with traditional cardiovascular risk factors and outcomes, they may be potentially modifiable risk factors for stroke and death in community-dwelling adults.
钙磷水平与慢性肾脏病中的血管功能障碍相关，可能是社区居住成年人冠心病、中风和死亡的新危险因素。
我们在基于社区的前瞻性动脉粥样硬化风险社区研究（n = 15732）中进行了12.6年的随访来验证这一假设。
在基线时，血清钙的均值（标准差）为9.8（0.4）mg/dL，血清磷为3.4（0.5）mg/dL，钙磷乘积为33.6（5.3）mg²/dL²，年龄为54.2（5.7）岁，肾小球滤过率（GFR）为93.1（21.5）mL/min per 1.73 m²。钙、磷和钙磷乘积的共同关联因素包括年龄较大、女性、非裔美国人种族、吸烟年数、当前吸烟、低体重指数、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、低血清白蛋白、低GFR、低热量摄入和磷摄入。在调整年龄、人口统计学特征、合并症、白蛋白和GFR后，钙与冠心病、中风和死亡的风险比分别为1.01（95%置信区间0.96 - 1.06）、1.16（1.07 - 1.26，P = 0.0005）和1.03（0.98 - 1.08）；磷相关的风险比分别为1.03（0.98 - 1.08）、1.11（1.02 - 1.21，P = 0.0219）和1.14（1.09 - 1.20，P < 0.0001）；钙磷乘积相关的风险比分别为1.03（0.98 - 1.08）、1.15（1.05 - 1.26，P = 0.0017）和1.15（1.09 - 1.20，P < 0.0001）。
尽管钙、磷和钙磷乘积水平与传统心血管危险因素和结局存在复杂关联，但它们可能是社区居住成年人中风和死亡的潜在可改变危险因素。
