Serum Phosphorus and Cardiovascular Mortality in Type 2 Diabetes
Serum Phosphorus and Cardiovascular Mortality in Type 2 Diabetes
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DOI：
10.1016/j.amjmed.2008.09.039
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发表时间：
2009-04-01
影响因子：
5.9
通讯作者：
Estacio, Raymond
中科院分区：
文献类型：
--
作者：
Chonchol, Michel;Dale, Rita;Estacio, Raymond
背景：尽管血清磷、钙和钙磷产物水平与肾功能正常患者的心血管事件和死亡率相关，但大多数研究并未检验这些矿物质与随时间重复收集的结果的关联。 方法：我们评估了 950 名适当研究参与者的血清磷、钙和钙磷产物水平与心血管事件和死亡率的关联。 糖尿病血压控制试验采用时间依赖性 Cox 回归模型（使用随时间测量的矿物质的累积平均值）和固定协变量 Cox 回归模型（仅使用这些矿物质的基线值）。 结果：参与者中有 42 例死亡和 193 例心血管事件，随机化后平均随访 4.8 年。与最低参考类别相比，基线血清磷 >3.9 mg/dL 和基线钙磷乘积 >36.8 mg(2)/dL(2) 与调整后的心血管死亡风险（风险比 [HR] 5.00；95% 置信区间 [CI]，1.70-14.72）和（HR 10.01；95% CI， 2.55-39.31），分别。然而，在研究过程中重复使用矿物质值的时间依赖性模型中，只有血清磷的平均值仍然显着（HR 4.25；95% CI，1.15 至 16.65）。结论：在糖尿病队列中的适当血压控制中，在时间依赖性 Cox 回归中，血清磷（而非血清钙或钙磷乘积）与心血管死亡率相关。 模型。因此，血清磷水平对于预测 2 型糖尿病患者的心血管死亡率可能更可靠。 (C) 2009 Elsevier Inc. 保留所有权利。 。美国医学杂志 (2009) 122, 380-386
BACKGROUND: Although serum phosphorus, calcium, and calcium-phosphorus product levels have been associated with cardiovascular events and mortality in patients with normal kidney function, most studies have not examined the association of these minerals with outcomes when collected repeatedly over time.METHODS: We evaluated the association of serum phosphorus, calcium, and calcium-phosphorus product levels with cardiovascular events and mortality in 950 participants of the Appropriate Blood Pressure Control in Diabetes trial by both time-dependent Cox regression models using the cumulative average of minerals measured over time and fixed covariate Cox regression models with only baseline values of these minerals.RESULTS: There were 42 deaths and 193 cardiovascular events among the participants, who were followed for an average of 4.8 years following randomization. A significant association was noted between baseline serum phosphorus >3.9 mg/dL and baseline calcium-phosphorus product >36.8 mg(2)/dL(2) compared with the lowest referent category with the adjusted risk of cardiovascular death (hazard ratio [HR] 5.00; 95% confidence interval [CI], 1.70-14.72) and (HR 10.01; 95% CI, 2.55-39.31), respectively. However, in time-dependent models using mineral values repeated during the course of the study, only the average of serum phosphorus remains significant (HR 4.25; 95% CI, 1.15 to 16.65).CONCLUSIONS: In the Appropriate Blood Pressure Control in Diabetes cohort, serum phosphorus, but not serum calcium or calcium-phosphorus product, was associated with cardiovascular mortality in time-dependent Cox regression models. Thus, serum phosphorus levels may be more reliable in predicting cardiovascular mortality in patients with type 2 diabetes. (C) 2009 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2009) 122, 380-386