Mortality from aortic stenosis: prospective study of serum calcium and phosphate.
Mortality from aortic stenosis: prospective study of serum calcium and phosphate.
复制标题
主动脉瓣狭窄死亡率：血清钙和磷酸盐的前瞻性研究。
DOI：
10.1111/joim.12593
复制
发表时间：
2017
影响因子：
11.1
通讯作者：
Wald DS
中科院分区：
文献类型：
--
作者：
Wald DS
目的探讨血清钙和磷酸盐水平与主动脉狭窄死亡的关系及其预防意义。方法采用前瞻性（巢式病例对照）分析英国联合预防协会前瞻性研究中21220例35-64岁男性的血清钙和磷酸盐水平，随访32年。49名基线无瓣膜性心脏病的男性随后死于主动脉狭窄。根据年龄、样品储存时间和冻融循环次数，每个人都与四个未受影响的对照组相匹配。通过logistic回归估计主动脉狭窄死亡的优势比。结果死于主动脉瓣狭窄者的平均血钙浓度高于未死于主动脉瓣狭窄者（2.44 vs 2.39 mmol L−1；P= 0.01）。钙含量最高的各组因主动脉狭窄死亡的风险是钙含量最低的组的2.87倍（95%可信区间1.22-6.76）。存在连续的剂量-反应关系；血清钙每增加0.1 mmol L−1，主动脉狭窄死亡风险增加51%(11-105%)，相当于每降低0.1 mmol L−1，风险降低34%（10-52%）。死于主动脉瓣狭窄者的血清磷酸盐水平没有显著高于未死于主动脉瓣狭窄者（1.0 vs. 0.99 mmol L−1；P= 0.76）。结论血钙水平与主动脉狭窄死亡率之间的关系具有潜在的预防意义。如果在其他类似的队列研究中得到定量证实，结果表明，非常小的血钙降低（约5%）可以转化为主动脉瓣狭窄的大幅减少（约三分之一）。
PurposeTo investigate the associations between levels of serum calcium and phosphate and subsequent death from aortic stenosis, and the implications for prevention.MethodsA prospective (nested case–control) analysis of serum calcium and phosphate levels was performed in stored samples from the British United Provident Association prospective study of 21 520 men aged 35–64, followed for up to 32 years. There were 49 men without baseline valvular heart disease who subsequently died of aortic stenosis. Each was matched, for age, duration of sample storage and number of freeze–thaw cycles, with four unaffected control subjects. Odds ratios for death from aortic stenosis were estimated by logistic regression.ResultsMean serum calcium concentration was higher in men who died of aortic stenosis than in those who did not (2.44 vs. 2.39 mmol L−1;P= 0.01). The risk of death from aortic stenosis in the highest calcium tertile was 2.87‐fold higher than in the lowest tertile (95% confidence interval 1.22–6.76). There was a continuous dose–response relationship; risk of death from aortic stenosis increased by 51% (11–105%) per 0.1 mmol L−1increase in serum calcium, equivalent to a 34% (10–52%) lower risk per 0.1 mmol L−1decrease. Serum phosphate was not significantly higher in men who died of aortic stenosis than in those who did not (1.0 vs. 0.99 mmol L−1;P= 0.76).ConclusionsThe association between serum calcium and subsequent mortality from aortic stenosis is of potential preventive significance. If confirmed quantitatively in other similar cohort studies, the results suggest that a very small reduction in serum calcium (about 5%) could translate into a large (about one‐third) reduction in aortic stenosis.