Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community
Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community
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DOI：
10.1001/archinte.167.9.879
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发表时间：
2007-05-14
影响因子：
--
通讯作者：
Vasan, Ramachandran S.
中科院分区：
文献类型：
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作者：
Dhingra, Ravi;Sullivan, Lisa M.;Vasan, Ramachandran S.
背景：慢性肾脏疾病（CKD）或既往心血管疾病（CVD）患者血清磷和钙磷产物水平升高与心血管疾病（CVD）死亡率增加相关。然而，目前尚不清楚血清磷水平是否影响无CKD或CVD个体的血管风险。方法：我们前瞻性评估了3368名Framingham Offspring研究参与者（平均年龄44岁，51%为女性）无CVD和CKD。我们使用多变量Cox模型将血清磷和钙水平与心血管疾病发病率联系起来。结果：在随访（平均持续时间16.1年）中，有524例CVD事件（159例为女性）。在多变量分析和调整已确定的危险因素以及肾小球滤过率、血红蛋白、血清白蛋白、蛋白尿和c反应蛋白水平时，较高的血清磷水平与心血管疾病风险的持续增加相关（每增加毫克/分升调整后的风险比为1.31；95%置信区间为1.05-1.63;P = 0.02；四分位数趋势的P值=）。004)。血清磷最高四分位数的个体与最低四分位数的个体相比，多变量调整后的心血管疾病风险为1.55倍（95%置信区间，1.16%-2.07%;P = 0.004）。这些发现在每4年更新一次心血管疾病危险因素的时间依赖模型中，以及在分析中仅限于无蛋白尿且肾小球滤过率估计大于90 mL/min / 1.73 m的个体中仍然是强有力的(2)。血清钙与CVD风险无关。结论：较高的血清磷水平与社区中无CKD和CVD个体CVD风险增加相关。这些观察结果强调需要进一步的研究来阐明磷稳态与血管风险之间的潜在联系。
Background: Higher levels of serum phosphorus and the calcium-phosphorus product are associated with increased mortality from cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) or prior CVD. However, it is unknown if serum phosphorus levels influence vascular risk in individuals without CKD or CVD.Methods: We prospectively evaluated 3368 Framingham Offspring study participants (mean age, 44 years; 51% were women) free of CVD and CKD. We used multivariable Cox models to relate serum phosphorus and calcium levels to CVD incidence.Results: On follow-up (mean duration, 16.1 years), there were 524 incident CVD events (159 in women). In multivariable analyses and adjusting for established risk factors and additionally for glomerular filtration rate and for hemoglobin, serum albumin, proteinuria, and C-reactive protein levels, a higher level of serum phosphorus was associated with an increased CVD risk in a continuous fashion (adjusted hazard ratio per increment of milligrams per deciliter, 1.31; 95% confidence interval, 1.05-1.63; P = .02; P value for trend across quartiles =. 004). Individuals in the highest serum phosphorus quartile experienced a multivariable-adjusted 1.55-fold CVD risk (95% confidence interval, 1.16%-2.07%; P = .004) compared with those in the lowest quartile. These findings remained robust in time-dependent models that up-dated CVD risk factors every 4 years and in analyses restricted to individuals without proteinuria and an estimated glomerular filtration rate greater than 90 mL/min per 1.73 m(2). Serum calcium was not related to CVD risk.Conclusion: Higher serum phosphorus levels are associated with an increased CVD risk in individuals free of CKD and CVD in the community. These observations emphasize the need for additional research to elucidate the potential link between phosphorus homeostasis and vascular risk.