Aceña A, Franco-Peláez J A, Gutierrez-Landaluce C, Pello A M, Cristóbal C, Tarín N, Huelmos A, Carda R, Martín-Mariscal M L, Alonso J, González-Parra E, González-Casaus M L, Lorenzo Ó, López Bescos L, Egido J, Tuñón J
Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain.
Nutr Metab Cardiovasc Dis. 2017 Sep;27(9):762-767. doi: 10.1016/j.numecd.2017.06.006. Epub 2017 Jun 15.
Calcidiol (vitamin D metabolite) plasma levels vary with sun exposure (SE). However, it is not known if SE influences its prognostic ability. We have studied the effect of SE on plasma levels of the components of mineral metabolism (calcidiol, fibroblast growth factor-23 [FGF-23], parathormone [PTH], and phosphate [P]) and on their prognostic value in patients with coronary artery disease (CAD).
We studied prospectively 704 patients with stable CAD. Clinical variables and baseline calcidiol, FGF-23, PTH, and P plasma levels were assessed. We divided the population in two subgroups, according to the period of plasma extraction: High SE (HSE) (April-September) and low SE (LSE) (October-March). The outcome was the development of acute ischemic events (acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Mean follow-up was 2.15 ± 0.99 years. Calcidiol and P levels were higher in HSE group. In the whole population, calcidiol (HR = 0.84 for each 5 ng/ml increase, 95% CI = 0.71-0.99; p = 0.038) and FGF-23 (HR = 1.14 for each 100 RU/ml increase, 95% CI = 1.05-1.23; p = 0.009) were predictors of the outcome, along with age, hypertension, body-mass index, peripheral artery disease, and P levels. In the LSE subgroup, calcidiol (HR = 0.75; 95% CI = 0.57-0.99; p = 0.034) and FGF-23 (HR = 1.34; 95% CI = 1.13-1.58; p = 0.003) remained as predictors of the outcome. In the HSE group calcidiol and FGF-23 had not independent prognostic value.
In patients with stable CAD, low calcidiol and high FGF-23 plasma levels predict an adverse prognosis only when the sample is obtained during the months with LSE. SE should be taken into account in the clinical practice.
骨化二醇（维生素D代谢产物）的血浆水平随日照量而变化。然而，尚不清楚日照量是否会影响其预后能力。我们研究了日照量对矿物质代谢成分（骨化二醇、成纤维细胞生长因子23 [FGF-23]、甲状旁腺激素[PTH]和磷酸盐[P]）血浆水平及其在冠心病（CAD）患者中的预后价值的影响。
我们前瞻性地研究了704例稳定型CAD患者。评估了临床变量以及骨化二醇、FGF-23、PTH和P的基线血浆水平。根据血浆提取时间，我们将人群分为两个亚组：高日照量（HSE）组（4月至9月）和低日照量（LSE）组（10月至次年3月）。结局为急性缺血事件（急性冠状动脉综合征、中风或短暂性脑缺血发作）、心力衰竭或死亡。平均随访时间为2.15±0.99年。HSE组的骨化二醇和P水平较高。在整个人群中，骨化二醇（每增加5 ng/ml，HR = 0.84，95% CI = 0.71 - 0.99；p = 0.038）和FGF-23（每增加100 RU/ml，HR = 1.14，95% CI = 1.05 - 1.23；p = 0.009）与年龄、高血压、体重指数、外周动脉疾病和P水平一样，是结局的预测因素。在LSE亚组中，骨化二醇（HR = 0.75；95% CI = 0.57 - 0.99；p = 0.034）和FGF-23（HR = 1.34；95% CI = 1.13 - 1.58；p = 0.003）仍然是结局的预测因素。在HSE组中，骨化二醇和FGF-23没有独立的预后价值。
在稳定型CAD患者中，只有在LSE月份采集样本时，低骨化二醇和高FGF-23血浆水平才预示不良预后。临床实践中应考虑日照量。
