Mineral metabolism disturbances are associated with the presence and severity of calcific aortic valve disease

Abstract

Abstract:Objective: We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease (CAVD) in patients with normal or mildly impaired renal function. Methods: We measured serum levels of calcium, phosphate, alkaline phosphatase (AKP), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-OHD), and biomarkers of bone turnover in 260 consecutive patients with normal or mildly impaired renal function and aortic valve sclerosis (AVSc) (n=164) or stenosis (AVS) (n=96) and in 164 age-and gender-matched controls. Logistic regression models were used to determine the association of mineral metabolism parameters with the presence and severity of CAVD. Results: Stepwise increases were observed in serum levels of calcium, phosphate, AKP, and iPTH from the control group to patients with AVS, and with reverse changes for 25-OHD levels (all P<0.001). Similarly, osteocalcin, procollagen I N-terminal peptide, and β-isomerized type I collagen C-telopeptide breakdown products were significantly increased stepwise from the control group to patients with AVS (all P<0.001). In patients with AVS, serum levels of iPTH were positively, in contrast 25-OHD levels were negatively, related to trans-aortic peak flow velocity and mean pressure gradient. After adjusting for relevant confounding variables, increased serum levels of calcium, phosphate, AKP, and iPTH and reduced serum levels of 25-OHD were independently associated with the presence and severity of CAVD. Conclusions: This study suggests an association between mineral metabolism disturbance and the presence and severity of CAVD in patients with normal or mildly impaired renal function. Abnormal bone turnover may be a potential mechanism.

Biomarkers of Calcific Aortic Valve Disease

“…In the largest such study, 260 AS patients were compared with 164 age and sex matched controls. Stepwise increases in serum calcium, phosphate, PTH, alkaline phosphatase, and stepwise decreases in serum 25-OH vitamin D, were significantly associated with increasing severity of AS 40 .…”

Apoptosis-mediated endothelial toxicity but not direct calcification or functional changes in anti-calcification proteins defines pathogenic effects of calcium phosphate bions

“…Increased serum calcium and phosphorus levels are associated with coronary artery disease, cerebrovascular events, peripheral artery disease, and heart valve calcification 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 . Furthermore, decreased serum fetuin-A and albumin levels are associated with the development of coronary artery disease and heart valve calcification 50 51 52 53 54 55 56 57 58 .…”

Association between homocysteine levels and calcific aortic valve disease: a systematic review and meta-analysis

“…Calcific aortic valve disease, which is considered to share similar biological processes with atherosclerosis, involves endothelial dysfunction, lipid infiltration, inflammation, oxidative stress and mineralization of aortic valves [ 7 ]. Previous studies have demonstrated an association of abnormal metabolism of calcium and lipid with the presence of CAVD [ 7 , 8 ]. Because increased Hcy levels can cause endothelial injury [ 9 ], Hcy has been hypothesized to initiate the inflammatory process and facilitate a series of reactions in CAVDs.…”