Onufrak Stephen J, Bellasi Antonio, Cardarelli Francesca, Vaccarino Viola, Muntner Paul, Shaw Leslee J, Raggi Paolo
Agricultural Research Service, US Department of Agriculture, Stoneville, Mississippi, USA.
Am J Epidemiol. 2009 Jan 1;169(1):67-77. doi: 10.1093/aje/kwn285. Epub 2008 Nov 2.
Serum phosphorus levels in the general population have been reported to be associated with cardiovascular morbidity and mortality and increased carotid intima-media thickness. The authors examined gender heterogeneity in the association of phosphorus with all-cause mortality and incident coronary artery disease using data from the Atherosclerosis Risk in Communities Study (1987-2001). Baseline phosphorus levels were higher in women and were associated differently among men and women with traditional atherosclerosis risk factors such as age, low density lipoprotein cholesterol, diabetes mellitus, and hypertension. In a multivariable-adjusted model, men in the highest quintile of serum phosphorus level (>3.8 mg/dL) had an increased mortality rate (hazard ratio = 1.45, 95% confidence interval: 1.12, 1.88), while women did not (hazard ratio = 1.18, 95% confidence interval: 0.89, 1.57). The multivariable likelihood ratio test of effect modification by gender was significant at alpha = 0.1 (P = 0.085) for all-cause mortality. Although the associations of phosphorus with coronary artery disease also appeared to differ substantially by gender, the multivariable test for effect modification suggested that the difference was consistent with random variation (P = 0.195). These results suggest the need for further investigation into gender differences in the contribution of mineral metabolism to cardiovascular disease in the general population.
据报道，普通人群的血清磷水平与心血管疾病的发病率和死亡率以及颈动脉内膜中层厚度增加有关。作者利用社区动脉粥样硬化风险研究（1987 - 2001年）的数据，研究了磷与全因死亡率和冠心病发病之间关联的性别异质性。女性的基线磷水平较高，并且在男性和女性中，磷与年龄、低密度脂蛋白胆固醇、糖尿病和高血压等传统动脉粥样硬化危险因素的关联有所不同。在多变量调整模型中，血清磷水平处于最高五分位数（>3.8mg/dL）的男性死亡率增加（风险比 = 1.45，95%置信区间：1.12, 1.88），而女性则没有（风险比 = 1.18，95%置信区间：0.89, 1.57）。对于全因死亡率，按性别进行效应修正的多变量似然比检验在α = 0.1时具有显著性（P = 0.085）。尽管磷与冠心病的关联在性别上似乎也有很大差异，但效应修正的多变量检验表明，这种差异与随机变异一致（P = 0.195）。这些结果表明，需要进一步研究矿物质代谢对普通人群心血管疾病贡献中的性别差异。
