title: Association of serum calcium and heart failure with preserved ejection fraction in patients with type 2 diabetes.
abstract: Type 2 diabetes mellitus (T2DM) is a recognized trigger factor for heart failure with preserved ejection fraction (HFpEF). Recent studies show that higher serum calcium level is associated with greater risk of both T2DM and heart failure. We speculate that increased serum calcium is related to HFpEF prevalence in patients with T2DM.
  
  
  
  In this cross-sectional echocardiographic study, 807 normocalcemia and normophosphatemia patients with T2DM participated, of whom 106 had HFpEF. Multinomial logistic regression was carried out to determine the variables associated with HFpEF. The associations between serum calcium and metabolic parameters, as well as the rate of HFpEF were examined using bivariate linear correlation and binary logistic regression, respectively. The predictive performance of serum calcium for HFpEF was evaluated using the area under the receiver operating characteristic curve (AUC).
  
  
  
  Patients with HFpEF have significantly higher serum calcium than those without HFpEF. Serum calcium was positively associated with total cholesterol, triglycerides, low-density lipoprotein cholesterol, serum uric acid, HOMA-IR and fasting plasma glucose. Compared with patients in the lowest serum calcium quartile, the odds ratio (OR) for HFpEF in patients in the highest quartile was 2.331 (95 % CI 1.088-4.994, p = 0.029). When calcium was analyzed as a continuous variable, per 1 mg/dL increase, the OR (95 % CI) for HFpEF was [2.712 (1.471-5.002), p = 0.001]. Serum calcium can predict HFpEF [AUC = 0.673, 95 % CI (0.620-0.726), p < 0.001].
  
  
  
  An increase in serum calcium level is associated with an increased risk of HFpEF in patients with T2DM.
authors.affiliation: Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Geriatrics, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Wu
authors.affiliation: Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
authors.forename: Wenling
authors.initials: W
authors.lastname: Dai
authors.affiliation: Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong University School of Medicine, Jinan, 250012, China.
authors.forename: Yintao
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Medical Laboratory, The Affiliated Hospital of Xuzhou Medical College, No. 99 Huaihai West Road, Xuzhou, 221000, China. sdjnshlb@126.com.
authors.forename: Shibao
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, 430060, China. zhongyuan_wen@163.com.
authors.forename: Zhongyuan
authors.initials: Z
authors.lastname: Wen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002118:Calcium / Q000097:blood*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007333:Insulin Resistance; D016014:Linear Models; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D012307:Risk Factors; D013318:Stroke Volume; D015854:Up-Regulation; D014527:Uric Acid / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids; D014527:Uric Acid; D002118:Calcium
keywords: Calcium; Heart failure with preserved ejection fraction; Type 2 diabetes mellitus