Columbia University, Department of Medicine, Division of Rheumatology, College of Physicians & Surgeons. New York, NY.
Arthritis Rheumatol. 2015 Jun;67(6):1465-1473. doi: 10.1002/art.39100.
To investigate the association between oral calcium supplementation and coronary artery calcification among rheumatoid arthritis (RA) patients without known cardiovascular disease (CVD).
This study was conducted as a nested, prospective cohort study of RA patients without known CVD. The daily supplemental calcium dose was ascertained from each patients' list of prescription and over-the-counter medications at baseline and at visit 2 (median 20 months postbaseline). The coronary artery calcium (CAC) score, a measure of coronary atherosclerosis, was assessed by cardiac multidetector row computed tomography at baseline and at visit 3 (median 39 months postbaseline). The association between calcium supplementation and CAC was explored.
Among the 145 RA patients studied, 42 (28%) were taking ≥1,000 mg/day of supplemental calcium at baseline. A CAC score of >100 units was seen in 44 patients (30%) at baseline and 50 patients (34%) at followup. Baseline CAC scores of >100 units were significantly less frequent in patients receiving the higher dosage (≥1,000 mg/day) of supplemental calcium than in those receiving the lower dosage (<1,000 mg/day) (odds ratio [OR] 0.28, 95% confidence interval [95% CI] 0.11-0.74); this association remained significant after adjustment for relevant confounders (adjusted OR 0.30, 95% CI 0.09-0.93). Similarly, at the third study visit, CAC scores of >100 units were less frequent in the higher supplemental calcium dose group compared to the lower dose group (OR 0.41, 95% CI 0.18-0.95); however, after adjustment for relevant confounders, the statistical significance of this association was lost (adjusted OR 0.39, 95% CI 0.14-1.12). No effect of sex heterogeneity was seen in the association of calcium supplementation with coronary artery calcification, and no change in the CAC score over time was observed.
Higher levels of oral calcium supplementation were not associated with an increased risk of coronary atherosclerosis, as measured by the CAC score, in this RA cohort.
研究类风湿关节炎（RA）患者中，无已知心血管疾病（CVD）患者口服补钙与冠状动脉钙化的相关性。
这是一项针对无已知 CVD 的 RA 患者的嵌套前瞻性队列研究。基线时和第 2 次就诊（中位随访时间为 20 个月）时，通过每位患者的处方药和非处方药清单确定每日补充钙剂量。基线和第 3 次就诊（中位随访时间为 39 个月）时通过心脏多层螺旋 CT 评估冠状动脉钙化（CAC）评分，该评分是冠状动脉粥样硬化的一种衡量指标。探讨钙补充与 CAC 之间的关系。
在研究的 145 例 RA 患者中，42 例（28%）基线时服用≥1000mg/天的补充钙。基线时 44 例（30%）和随访时 50 例（34%）患者的 CAC 评分>100 单位。与服用较低剂量（<1000mg/天）的患者相比，服用较高剂量（≥1000mg/天）的患者基线 CAC 评分>100 单位的频率显著降低（比值比[OR]0.28，95%置信区间[95%CI]0.11-0.74）；在调整相关混杂因素后，该关联仍然显著（调整 OR 0.30，95%CI 0.09-0.93）。同样，在第三次研究就诊时，与较低剂量组相比，较高剂量组的 CAC 评分>100 单位的频率较低（OR0.41，95%CI0.18-0.95）；然而，在调整相关混杂因素后，这种关联的统计学意义丧失（调整 OR0.39，95%CI0.14-1.12）。钙补充与冠状动脉钙化的相关性中未观察到性别异质性的影响，并且 CAC 评分随时间无变化。
在这项 RA 队列中，较高水平的口服钙补充与 CAC 评分所衡量的冠状动脉粥样硬化风险增加无关。
