Division of Nephology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Am J Clin Nutr. 2020 Jul 1;112(1):66-73. doi: 10.1093/ajcn/nqaa091.
There are limited data regarding the relation between serum phosphorus concentration (SPC) and subclinical coronary atherosclerosis in the asymptomatic healthy population without kidney dysfunction.
We aimed to investigate the relation between SPC and characteristics of atherosclerotic plaques and cardiac events according to SPCs using a large cohort of asymptomatic Korean individuals.
We evaluated 6329 asymptomatic Korean individuals [mean age: 53.6 ± 7.6 y, 4611 men (72.9%)] without kidney dysfunction and coronary artery disease who voluntarily underwent coronary computed tomography angiography (CCTA) as part of a general health examination. Study participants were stratified into quartiles according to their SPCs (≤3.0, 3.1-3.3, 3.4-3.7, ≥3.8 mg/dL). The degree and extent of subclinical coronary atherosclerosis were evaluated with CCTA. Stenosis of diameter ≥50% was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, and coronary revascularization.
After adjustment for cardiovascular disease risk factors, the risk of any atherosclerotic plaque was significantly higher with increasing SPC quartiles (P = 0.001). In particular, the risk of calcified plaque increased in the second (OR: 1.27; 95% CI: 1.07, 1.51; P = 0.006), third (OR: 1.39; 95% CI: 1.17, 1.64; P < 0.001), and fourth SPC quartiles (OR: 1.50; 95% CI: 1.24, 1.82; P < 0.001) compared with that in the first quartile. However, there were no significant differences in the adjusted ORs for noncalcified plaque, mixed plaque, or significant stenosis. During a follow-up of median 5.4 y, there was no significant difference in cardiac events between the SPC quartiles.
In asymptomatic Korean individuals without kidney dysfunction, a high SPC was an independent predictor of calcified plaques without any difference in cardiac events. Further long-term prospective studies are required to validate these results.
在肾功能正常的无症状健康人群中，有关血清磷浓度（SPC）与亚临床冠状动脉粥样硬化之间关系的数据有限。
我们旨在通过对大量无症状韩国个体进行研究，根据 SPC 评估 SPC 与动脉粥样硬化斑块特征和心脏事件之间的关系。
我们评估了 6329 名无症状韩国个体[平均年龄：53.6±7.6 岁，4611 名男性（72.9%）]，他们无肾功能障碍且未患有冠状动脉疾病，自愿接受冠状动脉计算机断层扫描血管造影（CCTA）作为一般健康检查的一部分。研究参与者根据其 SPC 分为四分位数（≤3.0、3.1-3.3、3.4-3.7、≥3.8mg/dL）。通过 CCTA 评估亚临床冠状动脉粥样硬化的程度和范围。直径狭窄≥50%定义为显著狭窄。心脏事件定义为全因死亡、心肌梗死、不稳定型心绞痛和冠状动脉血运重建的综合结果。
在调整心血管疾病危险因素后，随着 SPC 四分位数的增加，任何动脉粥样硬化斑块的风险显著增加（P=0.001）。特别是，在第二（OR：1.27；95%CI：1.07，1.51；P=0.006）、第三（OR：1.39；95%CI：1.17，1.64；P<0.001）和第四 SPC 四分位数（OR：1.50；95%CI：1.24，1.82；P<0.001）中，钙化斑块的风险增加，与第一四分位数相比。然而，非钙化斑块、混合斑块或显著狭窄的校正 OR 无显著差异。在中位随访 5.4 年后，SPC 四分位数之间的心脏事件无显著差异。
在肾功能正常的无症状韩国个体中，高 SPC 是钙化斑块的独立预测因子，而心脏事件无差异。需要进一步的长期前瞻性研究来验证这些结果。
