Coronary artery calcification and aortic valve calcification in patients with kidney failure: a sex-disaggregated study

Ward, Liam J.; Laučytė-Cibulskienė, Agnė; Hernandez, Leah; Ripsweden, Jonaz; Pilote, Louise; Norris, Colleen M.; Raparelli, Valeria; Kautzky‐Willer, Alexandra; Herrero, María Trinidad; Stenvinkel, Peter; Kublickiene, Karolina

doi:10.1186/s13293-023-00530-x

Cited by 3 publications

(4 citation statements)

References 48 publications

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“…200 Further, risk factors for calcification progression are different. 201,202 Females also have a lower incidence of CVD compared with males; however, it rises following menopause. 203,204 It is attractive to speculate that sex differences in phosphate metabolism after menopause may, in part, underlie this rise in CVD incidence.…”

Section: Potential Role Of Sex In Phosphate-mediated Cvdmentioning

confidence: 99%

Phosphate in Cardiovascular Disease: From New Insights Into Molecular Mechanisms to Clinical Implications

Turner,

Beck,

Hill Gallant

et al. 2024

ATVB

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Hyperphosphatemia is a common feature in patients with impaired kidney function and is associated with increased risk of cardiovascular disease. This phenomenon extends to the general population, whereby elevations of serum phosphate within the normal range increase risk; however, the mechanism by which this occurs is multifaceted, and many aspects are poorly understood. Less than 1% of total body phosphate is found in the circulation and extracellular space, and its regulation involves multiple organ cross talk and hormones to coordinate absorption from the small intestine and excretion by the kidneys. For phosphate to be regulated, it must be sensed. While mostly enigmatic, various phosphate sensors have been elucidated in recent years. Phosphate in the circulation can be buffered, either through regulated exchange between extracellular and cellular spaces or through chelation by circulating proteins (ie, fetuin-A) to form calciprotein particles, which in themselves serve a function for bulk mineral transport and signaling. Either through direct signaling or through mediators like hormones, calciprotein particles, or calcifying extracellular vesicles, phosphate can induce various cardiovascular disease pathologies: most notably, ectopic cardiovascular calcification but also left ventricular hypertrophy, as well as bone and kidney diseases, which then propagate phosphate dysregulation further. Therapies targeting phosphate have mostly focused on intestinal binding, of which appreciation and understanding of paracellular transport has greatly advanced the field. However, pharmacotherapies that target cardiovascular consequences of phosphate directly, such as vascular calcification, are still an area of great unmet medical need.

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Section: Potential Role Of Sex In Phosphate-mediated Cvdmentioning

confidence: 99%

Phosphate in Cardiovascular Disease: From New Insights Into Molecular Mechanisms to Clinical Implications

Turner,

Beck,

Hill Gallant

et al. 2024

ATVB

View full text Add to dashboard Cite

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“…222 While calcification occurs on any heart valve, the aortic valve is the most commonly affected. 222,223 Moreover, valvular calcification results in valvular stenosis, causing decreased blood flow through the valve, which results in organ hypoperfusion, heart failure, and arrhythmia due to electrical disturbances in the heart. 224,225 Blood Pressure Regulation…”

Section: Valvular Heart Diseasementioning

confidence: 99%

“…221 In patients with CKD, calcification of the heart valves causes stiffness and reduced functionality of the affected valves. 222 While calcification occurs on any heart valve, the aortic valve is the most commonly affected. 222,223 Moreover, valvular calcification results in valvular stenosis, causing decreased blood flow through the valve, which results in organ hypoperfusion, heart failure, and arrhythmia due to electrical disturbances in the heart.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways

Curaj,

Vanholder,

Loscalzo

et al. 2024

Circulation Research

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The crosstalk of the heart with distant organs such as the lung, liver, gut, and kidney has been intensively approached lately. The kidney is involved in (1) the production of systemic relevant products, such as renin, as part of the most essential vasoregulatory system of the human body, and (2) in the clearance of metabolites with systemic and organ effects. Metabolic residue accumulation during kidney dysfunction is known to determine cardiovascular pathologies such as endothelial activation/dysfunction, atherosclerosis, cardiomyocyte apoptosis, cardiac fibrosis, and vascular and valvular calcification, leading to hypertension, arrhythmias, myocardial infarction, and cardiomyopathies. However, this review offers an overview of the uremic metabolites and details their signaling pathways involved in cardiorenal syndrome and the development of heart failure. A holistic view of the metabolites, but more importantly, an exhaustive crosstalk of their known signaling pathways, is important for depicting new therapeutic strategies in the cardiovascular field.

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“…However, women have higher autoimmunity risk as exemplified by the higher incidence of systemic lupus erythematosus and rheumatoid arthritis [ 74 , 82 ]. Among dialysis patients, coronary artery calcification had a sex-specific signature, as females were more often inflamed (higher IL-6 and TNF levels) than men [ 90 ]. Finally, sex differences in CVD risk factors do influence outcomes as adjustment for traditional CV risk factors and CRP in observational studies in non-dialysis CKD populations, reduced the sex risk difference for heart failure, death [ 33 ], or MACE [ 39 ].…”

Section: Risk Factors For Cvd In Men and Women With Ckdmentioning

confidence: 99%

Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

Balafa,

Fernandez-Fernandez,

Ortiz

et al. 2024

Clinical Kidney Journal

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Sex (biologically determined) and gender (socially constructed) modulate manifestations and prognosis of a vast number of diseases, including cardiovascular disease (CVD) and chronic kidney disease (CKD). CVD remains the leading cause of death in CKD patients. Population-based studies indicate that women present a higher prevalence of CKD and experience less CVD than men in all CKD stages, although this is not as clear in patients on dialysis or transplantation. When compared to the general population of the same sex, CKD has a more negative impact on women on kidney replacement therapy. European women on dialysis or recipients of kidney transplants have life expectancy up to 44.8 and 19.8 years lower, respectively, than their counterparts of similar age in the general population. For men, these figures stand at 37.1 and 16.5 years, representing a 21% to 20% difference, respectively. Hormonal, genetic, societal, and cultural influences may contribute to these sex-based disparities. To gain a more comprehensive understanding of these differences and their implications for patient care, well-designed clinical trials that involve a larger representation of women and focus on sex-related variables are urgently needed. This narrative review emphasizes the importance of acknowledging the epidemiology and prognosis of sex disparities in CVD among CKD patients. Such insights can guide research into the underlying pathophysiological mechanisms, leading to optimized treatment strategies and ultimately, improved clinical outcomes.

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Coronary artery calcification and aortic valve calcification in patients with kidney failure: a sex-disaggregated study

Cited by 3 publications

References 48 publications

Phosphate in Cardiovascular Disease: From New Insights Into Molecular Mechanisms to Clinical Implications

Phosphate in Cardiovascular Disease: From New Insights Into Molecular Mechanisms to Clinical Implications

Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways

Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

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