Department of Medicine, University of California, San Francisco, California, USA.
Am J Cardiol. 2012 Dec 15;110(12):1729-34. doi: 10.1016/j.amjcard.2012.08.007. Epub 2012 Sep 10.
We sought to evaluate the association of urine calcium excretion (UCaE), which reflects systemic calcium absorption, with cardiovascular (CV) events and mortality in outpatients with prevalent coronary heart disease (CHD). Calcium supplementation is associated with vascular calcification and adverse CV outcomes in patients with end-stage renal disease. Recent studies have raised concern that this phenomenon may also extend to the general population. However, previous studies have assessed oral calcium intake, which correlates poorly with systemic calcium absorption. We measured UCaE from 24-hour urine collections provided by 903 outpatients who were recruited from 2000 to 2002. We used Cox proportional hazard models to evaluate the association of baseline UCaE with a primary end point of any CV event (myocardial infarction [MI], heart failure, stroke, or CV mortality). During a mean follow-up of 6 ± 3 years, 287 subjects (32%) had a CV event. After multivariate adjustment for demographics, traditional CV risk factors, and kidney function, there was no association between UCaE and the primary end point of any CV event (per 10-mg/day greater UCaE, hazard ratio 1.00, 95% confidence interval 0.98 to 1.02). Evaluation of individual CV outcomes revealed a lower rate of MI with higher UCaE (hazard ratio 0.97, 95% confidence interval 0.94 to 1.00). In conclusion, greater UCaE is not associated with higher overall CV event rates or mortality in outpatients with stable CHD. On the contrary, greater UCaE is associated with a modestly lower rate of MI. These findings suggest that greater systemic calcium absorption does not confer CV harm in outpatients with prevalent CHD.
我们旨在评估尿钙排泄量（UCaE）与已确诊冠心病（CHD）患者心血管（CV）事件和死亡率之间的相关性。钙补充剂与终末期肾病患者的血管钙化和不良 CV 结局有关。最近的研究引起了人们的关注，即这种现象可能也会扩展到一般人群。然而，以前的研究评估了口服钙摄入量，这与系统钙吸收相关性较差。我们从 2000 年至 2002 年招募的 903 名门诊患者的 24 小时尿液采集物中测量了 UCaE。我们使用 Cox 比例风险模型评估基线 UCaE 与任何 CV 事件（心肌梗死[MI]、心力衰竭、中风或 CV 死亡率）的主要终点之间的相关性。在平均 6±3 年的随访期间，287 名患者（32%）发生了 CV 事件。在调整人口统计学、传统 CV 危险因素和肾功能后，UCaE 与任何 CV 事件的主要终点之间没有关联（每增加 10mg/天 UCaE，风险比 1.00，95%置信区间 0.98 至 1.02）。对个别 CV 结局的评估显示，较高的 UCaE 与较低的 MI 发生率相关（风险比 0.97，95%置信区间 0.94 至 1.00）。总之，在稳定的 CHD 门诊患者中，较高的 UCaE 与总体 CV 事件发生率或死亡率升高无关。相反，较高的 UCaE 与 MI 发生率的适度降低相关。这些发现表明，在患有普遍 CHD 的门诊患者中，更大的系统钙吸收不会带来 CV 危害。
