Dietary Intake of Calcium and Phosphorus and Serum Concentration in Relation to the Risk of Coronary Artery Calcification in Asymptomatic Adults

Abstract

Objective-The current data regarding the association between calcium and phosphorus and cardiovascular disease are lacking. The aim of this study was to explore whether dietary calcium and phosphorus intake and their serum levels are associated with the prevalence of coronary artery calcification (CAC) using cardiac computed tomography in asymptomatic participants without a history of chronic kidney disease or cardiovascular disease. Approach and Results-A cross-sectional study was performed in 23 652 Korean participants (40.8±7.3 years, male 83.5%) without chronic kidney disease (estimated glomerular filtration rate≥60 mL/min per 1.73 m 2 ) or clinically overt cardiovascular disease, who underwent cardiac computed tomographic estimation of CAC scores as part of a general health checkup in addition to completing a self-administered food frequency questionnaire. We assessed the relationship of dietary calcium and phosphorus intake and serum levels with CAC scores using both multivariate-adjusted Tobit models and multinomial logistic regression models. Neither dietary calcium nor phosphorus intake was consistently associated with CAC scores. However, the serum calcium, phosphorus, and calcium-phosphorus product levels were significantly associated with the CAC score ratios. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest quartiles of serum calcium, phosphorus, and calcium-phosphorus product levels to the lowest quartiles were 1.89 (1.36-2.64), 3.33 (2.55-4.35), and 3.98 (3.00-5.28), respectively (P for trend <0.001). Previous studies suggested that higher serum phosphorus levels (even within normal ranges), but not calcium levels, may be a risk factor for coronary artery disease. Few studies have examined the relationship between dietary intake of calcium and phosphorus and CAC formation. The Framingham cohort study 16 found that total daily calcium intake from the diet and supplements is not associated with increased CAC among 690 women and 588 men over a 4-year follow-up period. Conclusions-ElevatedTo our knowledge, no study has closely analyzed the association between dietary intake of calcium and phosphorus and serum concentrations and the risk of CAC in an Asian population. Assessing the different effects of dietary intake of these minerals and their serum levels on the risk of coronary artery disease may help in identifying factors contributing to the progression of coronary artery atherosclerosis. In this study, we assessed whether dietary calcium and phosphorus intake and their serum levels are associated with CAC using cardiac computed tomography in asymptomatic participants without a history of CKD and CVD. Materials and MethodsMaterials and Methods are available in the online-only Supplement. ResultsThe mean (SD) age and body mass index of the 23 652 participants were 40.8 (7.3) years and 24.3 (3.1) kg/m 2 , respectively. The prevalence of hypertension and diabetes mellitus was 13.8% and 5.3%, respectively. The median (interquartile range) dietary...

Cardiovascular Calcification and Bone: A Comparison of The Effects of Dietary and Serum Calcium, Phosphorous, Magnesium and Vitamin D

“…These studies demonstrate that even a serum phosphate value within the reference range (0.8-1.4mmol/l) is associated with CV calcification, as well as increased CV risk [66]. Studies of older adults and CKD patients also found a significant association between higher serum phosphate and presence and extent of calcification 18,21,22,26,28,29 , with each 0.0323mmol/l rise in serum phosphorus being associated with 6.1% higher odds of having CAC 21 . Wang et al found a gender difference; in postmenopausal women, serum phosphate was significantly higher (1.15 vs 1.17 mmol/l) in subjects with AAC, while in older men there was no association 19 .…”

“…Observational studies generally show little association of calcium intake, dietary or supplemental, with coronary artery calcification (CAC) or abdominal aortic calcification (AAC) incidence or extent in older adults 4,[15][16][17][18] , although a large study showed that calcium intake was significantly higher in postmenopausal men and women without AAC at baseline and in women only after five years 19 . Koreans with the highest calcium intake (>840mg/d) also had improved serum lipid profiles 20 .…”

“…Koreans with the highest calcium intake (>840mg/d) also had improved serum lipid profiles 20 . Many studies of serum calcium show no association with calcification [21][22][23][24][25] , although some show a positive correlation with presence, extent and progression of AAC in older adults 19,[26][27] , with mixed results for presence of CAC, although there may be an association with extent or progression [18][19][28][29] . Serum calcium was an independent predictor of calcified and mixed plaque but not non-calcified plaque 29 and higher concentrations were associated with lower in-hospital mortality among MI patients 30 .…”

“…In the few studies of the effect of dietary phosphorus on human CV calcification there is no association in older Koreans 18 , although animal studies show a positive association between phosphorus intake and aortic and renal calcification and atheroma incidence [71][72] . found a significant association between baseline mean serum phosphate levels (>1.292mmol/l vs ≤0.969mmol/l) and baseline aortic valve calcification (AVC), mitral annulus calcification (MAC) and AAC presence but not with extent, progression or new development after a mean of 2.4 years; the association with AAC lost significance after adjustment 25,73 .…”

Fatores dietéticos associados à calcificação vascular em pacientes com doença renal crônica em tratamento conservador

“…Diversos estudos experimentais demonstraram que uma dieta rica em fósforo promove calcificação (38,59,172,173). Já em humanos, em um estudo transversal realizado em participantes com função renal normal, não houve associação entre a ingestão de fósforo e CV (174). Contudo, nesse único estudo que avaliou a relação entre o consumo de fósforo e CV, a ingestão do mineral foi menor do que no presente projeto.…”