Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN 55417, United States.
Int J Cardiol. 2011 Jun 16;149(3):335-40. doi: 10.1016/j.ijcard.2010.02.013. Epub 2010 Mar 1.
There is increasing evidence linking phosphorus and calcium levels to a higher risk of cardiovascular morbidity and mortality in the general population.
We performed a post hoc data analysis from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial of raloxifene treatment in 7259 postmenopausal women with osteoporosis to test the hypothesis that higher baseline calcium and phosphorus levels are associated with a higher risk of incident cardiovascular events during 4years of follow-up.
Baseline mean (SD) values were 2.3 (0.1)mmol/L for serum calcium, 1.2 (0.2)mmol/L for serum phosphorus. Adjusted for multiple covariates including 25(OH)D, parathyroid hormone, and phosphorus, adjusted hazard ratios (AHR) (95% confidence interval (CI)) per SD of calcium were: 1.17(1.01-1.35), p=0.03 for combined cardiovascular outcome, 1.22(0.99-1.49), p=0.06 for cerebrovascular events, 1.12(0.92-1.37), p=0.25 for coronary heart disease, and 1.18(0.94-1.48), p=0.16 for death. While there was some evidence that higher serum phosphorus levels were associated with higher rate of combined cardiovascular outcome (p=0.07) and cerebrovascular events (p=0.03) in pauci-variable analysis, these associations did not persist after adjustment for additional confounders. Adjusted for multiple covariates including 25(OH)D, parathyroid hormone, and calcium, AHR(95% CI) per SD of phosphorus were 0.88(0.77-1.01), p=0.07 for combined cardiovascular outcome, 0.86(0.70-1.06), p=0.15 for ceverbrovascular events, 0.92(0.76-1.10), p=0.35 for coronary heart disease, and 1.00(0.80-1.25) for death.
We found an independent association between higher baseline serum calcium levels and higher rate of cardiovascular events. Our findings did not support an independent association between serum phosphorus levels and cardiovascular events.
越来越多的证据表明，磷和钙水平与普通人群心血管发病率和死亡率的升高有关。
我们对雷洛昔芬治疗骨质疏松症的多结局雷洛昔芬评估（MORE）试验中的 7259 名绝经后妇女进行了事后数据分析，以检验基线时钙和磷水平较高与 4 年随访期间心血管事件发生率升高相关的假设。
基线时血清钙的平均值（标准差）为 2.3（0.1）mmol/L，血清磷为 1.2（0.2）mmol/L。在校正了包括 25（OH）D、甲状旁腺激素和磷在内的多个协变量后，钙的每标准差调整后的危害比（AHR）（95%置信区间（CI））为：综合心血管结局 1.17（1.01-1.35），p=0.03；脑血管事件 1.22（0.99-1.49），p=0.06；冠心病 1.12（0.92-1.37），p=0.25；死亡 1.18（0.94-1.48），p=0.16。虽然 pauci-variable 分析中有一些证据表明较高的血清磷水平与较高的综合心血管结局发生率（p=0.07）和脑血管事件发生率（p=0.03）相关，但在校正了其他混杂因素后，这些相关性并未持续存在。在校正了包括 25（OH）D、甲状旁腺激素和钙在内的多个协变量后，磷的每标准差调整后的 AHR（95% CI）为综合心血管结局 0.88（0.77-1.01），p=0.07；脑血管事件 0.86（0.70-1.06），p=0.15；冠心病 0.92（0.76-1.10），p=0.35；死亡 1.00（0.80-1.25）。
我们发现基线时血清钙水平较高与心血管事件发生率升高之间存在独立关联。我们的研究结果不支持血清磷水平与心血管事件之间存在独立关联。
