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Associations between serum calcium, phosphorus and mortality among patients with coronary heart disease

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Abstract

Purpose

Serum calcium and phosphorus abnormalities are associated with cardiovascular disorders in general population, but evidence among patients with established coronary heart disease (CHD) is limited and controversial. This study aimed to investigate the associations of baseline serum calcium and phosphorus levels with long-term mortality risk among patients with CHD.

Methods

We conducted a prospective cohort study among 3187 patients with CHD from October 2008 and December 2011 in China. Cox proportional hazards model was used to assess the associations of serum calcium and phosphorus at baseline with the risk of death.

Results

During follow-up (mean, 4.9 years), 295 patients died, 193 of which resulted from cardiovascular causes. Multivariable-adjusted hazard ratios (HR) for each 1 mmol/L increase in serum calcium at baseline were 0.27 (95% confidence interval (CI) 0.14–0.51) for all-cause mortality and 0.26 (95% CI 0.12–0.54) for cardiovascular mortality. Patients in the highest compared to the lowest quartile of serum calcium were at lower risk of all-cause mortality (HR, 95% CI 0.57, 0.40–0.82) and cardiovascular mortality (0.50, 0.32–0.79) (both P trend < 0.001). This inverse association between serum calcium and the risk of mortality did not change when participants were stratified by sex, age groups, level of overweight, types of CHD, and history of diabetes. We also observed a graded positive association between baseline serum phosphorus and the risks of mortality.

Conclusions

The present study is the first to report that lower serum calcium at baseline is associated with an increased risk of all-cause and cardiovascular mortality in a Chinese coronary heart disease cohort. Further studies are required to investigate the causal relationship and actual mechanisms.

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Acknowledgements

This study was supported by the State Key Program of National Natural Science Foundation of China (Grant 81130052 and Grant 81402671). Qian Chen is supported by International Program for Ph.D. Candidates, Sun Yat-sen University.

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Author notes

  1. Qian Chen and Yuan Zhang contributed equally to the study.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangdong, 510080, China

    Qian Chen, Ding Ding, Dan Li, Yunou Yang, Qing Li, Xuechen Chen & Wenhua Ling

  2. Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA

    Qian Chen & Gang Hu

  3. Department of Cardiology, General Hospital of Guangzhou Military Command of People’s Liberation Army, Guangzhou, China

    Yuan Zhang

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  1. Qian Chen
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Correspondence to Gang Hu or Wenhua Ling.

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Chen, Q., Zhang, Y., Ding, D. et al. Associations between serum calcium, phosphorus and mortality among patients with coronary heart disease. Eur J Nutr 57, 2457–2467 (2018). https://doi.org/10.1007/s00394-017-1518-8

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