Tuñón José, Cristóbal Carmen, Tarín Nieves, Aceña Álvaro, González-Casaus María Luisa, Huelmos Ana, Alonso Joaquín, Lorenzo Óscar, González-Parra Emilio, Mahíllo-Fernández Ignacio, Pello Ana María, Carda Rocío, Farré Jerónimo, Rodríguez-Artalejo Fernando, López-Bescós Lorenzo, Egido Jesús
Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
Department of Cardiology, Hospital de Fuenlabrada, Fuenlabrada, Spain; Rey Juan Carlos University, Alcorcón, Spain.
PLoS One. 2014 Apr 18;9(4):e95402. doi: 10.1371/journal.pone.0095402. eCollection 2014.
Vitamin D and fibroblast growth factor-23 (FGF-23) are related with cardiovascular disorders. We have investigated the relationship of calcidiol (vitamin D metabolite) and FGF-23 plasma levels with the incidence of adverse outcomes in patients with coronary artery disease.
Prospective follow-up study of 704 outpatients, attending the departments of Cardiology of four hospitals in Spain, 6-12 months after an acute coronary event. Baseline calcidiol, FGF-23, parathormone, and phosphate plasma levels were assessed. The outcome was the development of acute ischemic events (any acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Cox regression adjusted for the main confounders was performed.
Calcidiol levels showed a moderate-severe decrease in 57.3% of cases. Parathormone, FGF-23, and phosphate levels were increased in 30.0%, 11.5% and 0.9% of patients, respectively. Only 22.4% of patients had glomerular filtration rate<60 ml/min1.73 m2. After a mean follow-up was 2.15±0.99 years, 77 patients developed the outcome. Calcidiol (hazard ratio [HR] = 0.67; 95% confidence interval [CI] = 0.48-0.94; p = 0.021) and FGF-23 (HR = 1.13; 95% CI = 1.04-1.23; p = 0.005) plasma levels predicted independently the outcome. There was a significant interaction between calcidiol and FGF-23 levels (p = 0.025). When the population was divided according to FGF-23 levels, calcidiol still predicted the outcome independently in patients with FGF-23 levels higher than the median (HR = 0.50; 95% CI = 0.31-0.80; p = 0.003) but not in those with FGF-23 levels below this value (HR = 1.03; 95% CI = 0.62-1.71; p = 0.904).
Abnormalities in mineral metabolism are frequent in patients with stable coronary artery disease. In this population, low calcidiol plasma levels predict an adverse prognosis in the presence of high FGF-23 levels.
维生素D和成纤维细胞生长因子-23（FGF-23）与心血管疾病相关。我们研究了25-羟维生素D（维生素D代谢产物）和FGF-23血浆水平与冠心病患者不良结局发生率之间的关系。
对西班牙四家医院心内科的704名门诊患者在急性冠脉事件发生6-12个月后进行前瞻性随访研究。评估基线时25-羟维生素D、FGF-23、甲状旁腺激素和磷酸盐的血浆水平。结局指标为急性缺血事件（任何急性冠脉综合征、中风或短暂性脑缺血发作）、心力衰竭或死亡。进行了校正主要混杂因素的Cox回归分析。
57.3%的病例中25-羟维生素D水平呈中度至重度下降。30.0%、11.5%和0.9%的患者甲状旁腺激素、FGF-23和磷酸盐水平升高。仅22.4%的患者肾小球滤过率<60 ml/min/1.73 m²。平均随访2.15±0.99年后，77例患者出现了上述结局。25-羟维生素D（风险比[HR]=0.67；95%置信区间[CI]=0.48-0.94；p=0.021）和FGF-23（HR=1.13；95%CI=1.04-1.23；p=0.005）血浆水平可独立预测结局。25-羟维生素D和FGF-23水平之间存在显著交互作用（p=0.025）。当根据FGF-23水平对人群进行划分时，25-羟维生素D在FGF-23水平高于中位数的患者中仍可独立预测结局（HR=0.50；95%CI=0.31-0.80；p=0.003），但在FGF-23水平低于该值的患者中则不能（HR=1.03；95%CI=0.62-1.71；p=0.904）。
稳定型冠心病患者中矿物质代谢异常很常见。在该人群中，低25-羟维生素D血浆水平在FGF-23水平升高时预示不良预后。
