Calcium, phosphate and the risk of cardiovascular events and all-cause mortality in a population with stable coronary heart disease.
OBJECTIVE
High serum calcium and phosphate levels have been linked to cardiovascular diseases and all-cause mortality but evidence from longitudinal studies is scarce, especially among patients with pre-existing coronary heart disease. The association between baseline calcium and phosphate and prognosis was examined in a cohort study of patients with stable coronary heart disease.


METHODS
Serum calcium and phosphate were measured in a cohort of initially 1206 patients undergoing a 3 week rehabilitation programme after an acute cardiovascular event and subsequently being followed-up for 8 years. Multivariate Cox regression was employed to assess the association of quartiles and continuous levels of calcium and phosphate with secondary cardiovascular events and all-cause mortality.


RESULTS
No significant risk elevations were observed for secondary cardiovascular event incidence in models adjusted for a variety of potential confounders. High calcium levels, however, were strongly associated with mortality risk in adjusted models (HR(Q4vsQ1)=2.39 (1.22 to 4.66)). In additional multivariable analyses, the calcium/albumin ratio was predictive for all-cause mortality (HR(Q4vsQ1)=2.66 (1.35 to 5.22)) and marginally predictive for cardiovascular event incidence (HR(Q4vsQ1)=1.74 (1.00 to 3.05)).


CONCLUSIONS
Calcium and the ratio of calcium with albumin, its major binding protein, were strongly associated with all-cause mortality among patients with coronary heart disease. The underlying mechanisms and the clinical implications of these findings deserve further study.
Division of Clinical Epidemiology and Aging Research C070, German Cancer Research Centre, POB 10 19 49, D-69009 Heidelberg, Germany.
Norma Christine
NC
Grandi
Hermann
H
Brenner
Harry
H
Hahmann
Bernd
B
Wüsten
Winfried
W
März
Dietrich
D
Rothenbacher
Lutz Philipp
LP
Breitling
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D002423:Cause of Death / Q000639:trends; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers; D010710:Phosphates; D002118:Calcium