Department of Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Department of Medicine, Division of Endocrinology, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Cardiovasc Diabetol. 2022 Apr 27;21(1):61. doi: 10.1186/s12933-022-01499-4.
Individuals with type 2 diabetes have a substantially elevated cardiovascular risk. A higher plasma phosphate level promotes vascular calcification, which may adversely affect outcomes in individuals with type 2 diabetes. We hypothesized that the association between plasma phosphate and all-cause mortality is stronger in individuals with type 2 diabetes, compared to those without diabetes.
We analysed the association between plasma phosphate and all-cause mortality in the Dutch population-based Lifelines cohort and in subgroups with and without type 2 diabetes, using multivariable Cox regression adjusted for potential confounders. Effect modification was tested using multiplicative interaction terms.
We included 57,170 individuals with 9.4 [8.8-10.4] years follow-up. Individuals within the highest phosphate tertile (range 1.00-1.83 mmol/L) were at higher risk of all-cause mortality (fully adjusted HR 1.18 [95% CI 1.02-1.36], p = 0.02), compared with the intermediate tertile (range 0.85-0.99 mmol/L). We found significant effect modification by baseline type 2 diabetes status (p-interaction = 0.003). Within the type 2 diabetes subgroup (N = 1790), individuals within the highest plasma phosphate tertile had an increased mortality risk (HR 1.73 [95% CI 1.10-2.72], p = 0.02 vs intermediate tertile). In individuals without diabetes at baseline (N = 55,380), phosphate was not associated with mortality (HR 1.12 [95% CI 0.96-1.31], p = 0.14). Results were similar after excluding individuals with eGFR < 60 mL/min/1.73 m.
High-normal plasma phosphate levels were associated with all-cause mortality in individuals with type 2 diabetes. The association was weaker and non-significant in those without diabetes. Measurement of phosphate levels should be considered in type 2 diabetes; whether lowering phosphate levels can improve health outcomes in diabetes requires further study.
2 型糖尿病患者的心血管风险显著升高。较高的血浆磷酸盐水平会促进血管钙化，这可能会对 2 型糖尿病患者的预后产生不利影响。我们假设，与无糖尿病患者相比，2 型糖尿病患者的血浆磷酸盐与全因死亡率之间的关联更强。
我们使用多变量 Cox 回归分析了荷兰基于人群的 Lifelines 队列中血浆磷酸盐与全因死亡率之间的关联，并在有和没有 2 型糖尿病的亚组中进行了分析，调整了潜在的混杂因素。使用乘法交互项测试了效应修饰。
我们纳入了 57170 名参与者，随访时间为 9.4 [8.8-10.4] 年。最高磷酸盐三分位组（范围 1.00-1.83 mmol/L）的全因死亡率风险较高（完全调整后的 HR 1.18 [95%CI 1.02-1.36]，p=0.02），与中间三分位组（范围 0.85-0.99 mmol/L）相比。我们发现基线 2 型糖尿病状态存在显著的效应修饰（p 交互=0.003）。在 2 型糖尿病亚组（N=1790）中，最高血浆磷酸盐三分位组的死亡率风险增加（HR 1.73 [95%CI 1.10-2.72]，p=0.02 与中间三分位组相比）。在基线时无糖尿病的个体（N=55380）中，磷酸盐与死亡率无关（HR 1.12 [95%CI 0.96-1.31]，p=0.14）。在排除 eGFR<60 mL/min/1.73 m 的个体后，结果相似。
高正常血浆磷酸盐水平与 2 型糖尿病患者的全因死亡率相关。在无糖尿病的患者中，这种关联较弱且无统计学意义。在 2 型糖尿病中应考虑测量磷酸盐水平；降低磷酸盐水平是否能改善糖尿病患者的健康结局还需要进一步研究。
