Impact of serum calcium and phosphate on coronary atherosclerosis detected by cardiac computed tomography

Shin, Sanghoon; Kim, Kwang Joon; Chang, Hyuk Jae; Cho, Iksung; Kim, Young Jin; Choi, Byoung Wook; Rhee, Yumie; Lim, Sung Kil; Yang, Woo In; Shim, Chi Young; Ha, Jong Won; Jang, Yangsoo; Chung, Namsik

doi:10.1093/eurheartj/ehs152

Cited by 75 publications

(70 citation statements)

References 40 publications

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“…Much work on the association between phosphate and CVD has focused on the link between phosphate and vascular calcification. [5][6][7][8] Our finding that serum phosphate relates to CVD death of non-CHD causes is consistent with the recent finding that phosphate is more related to calcified plaques, 31 which have been shown to be only weakly associated with the presence of coronary artery disease and less strongly associated with ischemic symptoms than noncalcified plaque. 32 Thus, the association between phosphate and calcified rather than noncalcified plaques may explain the weak association with CHD outcome (nonfatal MI and CHD death), which involves rupture of atherosclerotic plaque.…”

Section: Serum Phosphate and Cvdsupporting

confidence: 86%

Alkaline Phosphatase, Serum Phosphate, and Incident Cardiovascular Disease and Total Mortality in Older Men

Wannamethee

Sattar

Papcosta

et al. 2013

ATVB

107

110

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Objective-We have examined the association between serum phosphate and alkaline phosphatase (ALP) with incident cardiovascular disease (CVD) outcomes and total mortality in older men. Approach and Results-A prospective study of 3381 men, aged 60 to 79 years, without a history of myocardial infarction or stroke followed up for an average 11 years during which there were 605 major CVD events (fatal coronary heart disease and nonfatal myocardial infarction, stroke, and CVD death) and 984 total deaths. ALP but not serum phosphate was associated with increased risk of coronary heart disease and overall CVD events which persisted after adjustment for CVD risk factors and markers of inflammation and after exclusion of men with chronic kidney disease (adjusted hazard ratio per SD, Both raised phosphate and ALP were associated with significantly increased total mortality after full adjustment and exclusion of men with chronic kidney disease. Conclusions-ALP but not serum phosphate is associated with coronary heart disease risk in elderly men. High levels of ALP and serum phosphate are both associated with increased total mortality.

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Section: Serum Phosphate and Cvdsupporting

confidence: 86%

Alkaline Phosphatase, Serum Phosphate, and Incident Cardiovascular Disease and Total Mortality in Older Men

Wannamethee

Sattar

Papcosta

et al. 2013

ATVB

107

110

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“…In addition to the most commonly used imaging techniques at present, laboratory indexes, including lipoprotein(a), endothelin 1 and bone morphogenetic protein 2 levels, are also associated with calcification and may be utilized to assess the degree of CAC (19)(20)(21). To date, the association between serum calcium, phosphorus, CPP and CAC has been most widely discussed in previous studies (22,23); however, the conclusions are not consistent. The presence of cardiovascular risk factors may affect the results of these studies.…”

Section: Discussionmentioning

confidence: 99%

Correlation between serum parathyroid hormone levels and coronary artery calcification in patients without renal failure

et al. 2016

Biomedical Reports

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Abstract. The aim of the present study was to investigate the correlation between serum parathyroid hormone (PTH) levels and coronary artery calcification (CAC) in patients without renal failure, as well as to determine independent risk factors of CAC score (CACS). A total of 157 patients who underwent coronary computed tomography angiographic examination at the 101th Hospital of the People's Liberation Army between December 2013 and February 2015 were retrospectively evaluated. The correlation between PTH levels and CACS was determined using a Pearson correlation analysis. A receiver operating characteristic (ROC) curve was drawn to determine the best cutoff PTH level for prediction of CAC. The independent association between serum PTH levels and CAC was analyzed by using a logistic regression analysis model with the response variable Be binary class. The results revealed that PTH levels in patients in the CAC group were significantly higher than those of patients in the non-calcification group. PTH levels were positively correlated with CACS (r=0.288, P<0.001). The ROC curve suggested that a PTH level of ≥31.05 pg/ml was the best cut-off point for the prediction of CAC, with a sensitivity of 80.88%, specificity of 60.67% and an area under the curve of 0.761. After including predictive factors for CAC (gender, age, smoking status, diabetes, hypertension, hyperlipidemia, body mass index, glomerular filtration rate and calcium, phosphorus, calcium-phosphorus product, magnesium, PTH, total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol and C-reactive protein levels), the odds ratio of the serum PTH levels regarding the prediction of CAC was 1.050 (95% confidence interval, 1.027-1.074; P<0.001). In conclusion, the present study suggested that serum PTH levels are correlated with CAC in patients without renal failure and may thus be used as a reliable predictor of CAC.

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“…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 .…”

Section: Calcificationmentioning

confidence: 65%

“…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 . Nevertheless, serum calcium levels often bear little relationship to intake, as is evidenced by the study by Wang et al, where higher serum calcium was associated with increased AAC but a higher calcium intake was found in those with no AAC 19 .…”

Section: Calcificationmentioning

confidence: 99%

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

Nicoll¹

2015

ICFJ

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This comparison of the effects of calcium, phosphorus, magnesium and vitamin D on cardiovascular (CV) calcification and bone has shown that in general the micronutrients that promote bone health also protect the arteries. We have shown that adequate amounts of all three minerals should be ingested, paying particular attention to supplementing calcium to bind high phosphorus and to ensure the maximum benefit from supplementing vitamin D. It appears that the optimum intake for bone is >800 mg/d calcium, with postmenopausal women possibly requiring a total intake of >1100mg/d. Both CV and bone studies suggest achieving a serum 25(OH)D level of >75nmol/l. These relationships are valid for a Caucasian population, however, and may not hold in African Americans and Asians. The recent concerns that calcium supplementation may increase CV disease risk has largely proved groundless, with higher calcium intake improving dyslipidaemia, hypertension and mortality. With respect to higher serum phosphate, there is an association with CV calcification and CVD risk even within the normal range, suggesting that the reference ranges may need to be redefined for ‘at risk’ patients. CV calcification was reduced in CKD patients with magnesium intake in the range 384-669mg/d. When considering the complex interplay of the action of the minerals together with their regulators vitamin D, PTH and FGF23, it is clear that this is a very sophisticated system which attempts to maintain calcium homeostasis to the possible detriment of bone and arteries. This reinforces the need to ensure adequate calcium intake before supplementing vitamin D.

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Impact of serum calcium and phosphate on coronary atherosclerosis detected by cardiac computed tomography

Cited by 75 publications

References 40 publications

Alkaline Phosphatase, Serum Phosphate, and Incident Cardiovascular Disease and Total Mortality in Older Men

Alkaline Phosphatase, Serum Phosphate, and Incident Cardiovascular Disease and Total Mortality in Older Men

Correlation between serum parathyroid hormone levels and coronary artery calcification in patients without renal failure

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

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