Impact of serum calcium and phosphate on coronary atherosclerosis detected by cardiac computed tomography.
OBJECTIVE
High calcium (Ca), phosphate (P), and Ca-P product (CPP) are associated with cardiovascular disease in patients with chronic kidney disease. Whether this relationship persists in individuals with normal kidney function is not yet elucidated. We explored the relationship of serum Ca, P, and CPP to coronary atherosclerosis assessed by cardiac computed tomography angiography (cCTA) in participants with normal kidney function.


RESULTS
This study included 7553 participants (52 ± 10 years, male 57%) with near-normal kidney function (estimated glomerular filtration rate > 60 mL/min/1.73 m2) who underwent cCTA. The relationship of Ca, P, and CPP to coronary atherosclerosis [coronary artery Ca score (CACS) >100 and the presence of coronary artery disease (CAD)] was evaluated. Higher Ca, P, and CPP were significantly associated with CACS > 100 continuously [adjusted odds ratio (OR) per mg/dL: Ca 1.21, P = 0.026; P 1.29, P < 0.001; CPP 1.03, P < 0.001]. However, they correlate only weakly with the presence of CAD (OR: Ca 1.17, P = 0.001; P 1.05, P = 0.173; CPP 1.01, P = 0.034). This discrepancy was because calcified or mixed plaque and non-calcified plaque (NCP) were included in CAD. A significant relationship was demonstrated between calcified or mixed plaque and Ca, P, and CPP (OR: Ca 1.20, P = 0.001; P 1.13, P = 0.003; CPP 1.02, P = 0.001), but not NCP.


CONCLUSIONS
Elevated serum levels of Ca, P, and CPP are significantly associated with the presence of calcified coronary atherosclerotic plaque. It is unclear if there is a causal relationship. This relationship is thought to contribute to vascular calcification, but is less closely associated with NCP.
Division of Cardiology, Severance Cardiovascular Hospital,  Yonsei University College of Medicine, Yonsei University Health System, Seoul,  South Korea.
Sanghoon
S
Shin
Kwang-Joon
KJ
Kim
Hyuk-Jae
HJ
Chang
Iksung
I
Cho
Young Jin
YJ
Kim
Byoung-Wook
BW
Choi
Yumie
Y
Rhee
Sung-Kil
SK
Lim
Woo-In
WI
Yang
Chi-Young
CY
Shim
Jong-Won
JW
Ha
Yangsoo
Y
Jang
Namsik
N
Chung
D002118:Calcium / Q000097:blood*; D002130:Calcium Phosphates / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D010710:Phosphates / Q000097:blood*; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D061205:Vascular Calcification / Q000097:blood / Q000000981:diagnostic imaging
D002130:Calcium Phosphates; D010710:Phosphates; C020243:calcium phosphate; D002118:Calcium