Department of Medicine, Division of Cardiology, Jack D. Weiler Hospital, Montefiore Medical Center, Bronx, NY, USA.
Department of Medicine, Division of Cardiology, Jack D. Weiler Hospital, Montefiore Medical Center, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Atherosclerosis. 2019 Jun;285:79-86. doi: 10.1016/j.atherosclerosis.2019.04.215. Epub 2019 Apr 13.
Previous research has implicated dysregulation of phosphate metabolism and calcium-phosphate solubilization in cardiovascular calcification, but epidemiologic studies evaluating longitudinal associations with valvular or annular calcification by computed tomography (CT), a highly sensitive imaging modality, are lacking. Our primary aim was to investigate the associations of mineral biomarkers with incidence and progression of aortic valve calcification (AVC) and mitral annular calcification (MAC).
We evaluated the associations of serum FGF-23 (n = 6547 participants), phosphate (n = 6547), and fetuin-A (n = 2550) measured at baseline in the community-based Multi-Ethnic Study of Atherosclerosis with AVC and MAC on CT performed at baseline and at a median of 2.4 (1.6, 3.1) years later. We used linear mixed-effects models to account simultaneously for prevalence, incidence and progression of AVC and MAC.
After adjustment for demographic and clinical characteristics, a significant association was documented for FGF-23 with accelerated annual progression of MAC (2.83 Agatston units (AU), 95% CI = 0.49, 5.17 AU, per standard deviation (18.46 pg/mL) of FGF-23), but this was not seen for phosphate or fetuin-A. None of these biomarkers was associated with accelerated annual progression of AVC.
This study provides evidence relating serum FGF-23 to accelerated annual MAC progression. Whether this mineral regulator is a risk marker or is involved in pathogenesis merits further investigation.
先前的研究表明，磷酸盐代谢和钙磷溶解的失调与心血管钙化有关，但缺乏通过计算机断层扫描（CT）评估与瓣膜或环状钙化的纵向关联的流行病学研究，CT 是一种高度敏感的成像方式。我们的主要目的是研究矿物质生物标志物与主动脉瓣钙化（AVC）和二尖瓣环钙化（MAC）的发生率和进展之间的关联。
我们评估了社区为基础的动脉粥样硬化多民族研究中基线时血清 FGF-23（n=6547 名参与者）、磷酸盐（n=6547）和胎球蛋白 A（n=2550）与基线时 CT 检查中 AVC 和 MAC 以及中位数为 2.4（1.6，3.1）年后的 AVC 和 MAC 的关联。我们使用线性混合效应模型同时考虑 AVC 和 MAC 的患病率、发病率和进展情况。
在调整人口统计学和临床特征后，发现 FGF-23 与 MAC 的年度进展速度呈显著相关性（2.83 个 Agatston 单位（AU），95%可信区间[CI]为 0.49，5.17 AU，每标准偏差[18.46 pg/mL]的 FGF-23），但磷酸盐或胎球蛋白 A 则没有。这些生物标志物均与 AVC 的年度进展速度无关。
本研究提供了与血清 FGF-23 与 MAC 年度进展速度加快有关的证据。这种矿物质调节剂是风险标志物还是参与发病机制值得进一步研究。
