Grønhøj Mette Hjortdal, Gerke Oke, Mickley Hans, Steffensen Flemming Hald, Lambrechtsen Jess, Sand Niels Peter Rønnow, Rasmussen Lars Melholt, Olsen Michael Hecht, Diederichsen Axel
Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Centre of Health Economics Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
Atherosclerosis. 2016 Aug;251:101-108. doi: 10.1016/j.atherosclerosis.2016.06.001. Epub 2016 Jun 2.
High serum calcium-phosphate levels are associated with increased risk of cardiovascular disease (CVD) in patients with chronic kidney disease. Recent studies have demonstrated this relationship also in subjects with normal kidney function. Our aim was to examine whether calcium-phosphate metabolism is associated with the presence and extent of coronary artery calcification (CAC) in asymptomatic and apparently healthy individuals.
Serum samples from 1088 randomly recruited middle-aged men and women without known CVD and diabetes (DM), from the general population, were analysed for total calcium, phosphate, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25(OH)D). CAC was measured by a non-contrast cardiac CT scan and categorised into four groups: 0, 1-99, 100-399, ≥400 Agatston units. The association of calcium-phosphate metabolism with CAC was evaluated by a multiple ordered logistic regression model. All the multiple regression analyses were performed in the entire cohort as well as in men and women separately.
In the study population, 96% of the serum calcium values, 93% of the PTH values, 90% of the phosphate values, and only 64% of the 25(OH)D values were placed within the normal range. In men, the odds of being in a higher CAC category, i.e. having more severe CAC, increased by 30% when serum calcium concentration increased by 0.1 mmol/l (95% CI: 1.04-1.61, p = 0.019), independently of traditional cardiovascular risk factors. In women, no significant association between serum calcium and CAC was identified (OR 0.99, 95% CI: 0.81-1.21, p = 0.91). Neither phosphate, PTH nor 25(OH)D was significantly associated with CAC in men, in women or when performed in the entire cohort.
Serum calcium, even with values within normal range and independent of traditional risk factors, was significantly associated with CAC in asymptomatic and apparently healthy middle-aged men, but not in women.
慢性肾脏病患者血清钙磷水平升高与心血管疾病（CVD）风险增加相关。近期研究表明，在肾功能正常的人群中也存在这种关系。我们的目的是研究钙磷代谢是否与无症状且看似健康的个体冠状动脉钙化（CAC）的存在及程度相关。
从普通人群中随机招募1088名无已知CVD和糖尿病（DM）的中年男性和女性，分析其血清样本中的总钙、磷、甲状旁腺激素（PTH）和25-羟维生素D（25(OH)D）。通过非增强心脏CT扫描测量CAC，并分为四组：0、1 - 99、100 - 399、≥400阿加斯顿单位。采用多有序逻辑回归模型评估钙磷代谢与CAC的关联。所有多元回归分析在整个队列以及男性和女性中分别进行。
在研究人群中，96%的血清钙值、93%的PTH值、90%的磷值以及仅64%的25(OH)D值处于正常范围内。在男性中，血清钙浓度每增加0.1 mmol/l，处于更高CAC类别（即CAC更严重）的几率增加30%（95%置信区间：1.04 - 1.61，p = 0.019），独立于传统心血管危险因素。在女性中，未发现血清钙与CAC之间存在显著关联（比值比0.99，95%置信区间：0.81 - 1.21，p = 0.91）。在男性、女性或整个队列中，磷、PTH或25(OH)D与CAC均无显著关联。
血清钙即使在正常范围内且独立于传统危险因素，在无症状且看似健康的中年男性中也与CAC显著相关，但在女性中并非如此。
