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Nohara-Shitama Y, Mok Y, Ballew SH, Rebholz CM, Budoff MJ, Anderson C, Ishigami J, Blaha MJ, Matsushita K. Associations of Dietary Calcium and Phosphorus With Vascular and Valvular Calcification: The ARIC Study. JACC. ADVANCES 2024; 3:100993. [PMID: 39130050 PMCID: PMC11313033 DOI: 10.1016/j.jacadv.2024.100993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/28/2024] [Accepted: 04/02/2024] [Indexed: 08/13/2024]
Abstract
Background High dietary calcium and phosphorus may accelerate vascular calcification, but epidemiological data are inconsistent. Most of those studies assessed diet at one point and have not been systematically evaluated. Objectives The purpose of this study was to assess the associations of dietary calcium and phosphorus intakes in middle age with coronary artery and extra-coronary calcification at older age. Methods We studied 1,914 participants from the ARIC (Atherosclerosis Risk In Communities) study (mean age 80.5 years) without coronary heart disease who underwent chest computed tomography scans at visit 7 (2018-2019) and completed a 66-item food frequency questionnaire at 2 earlier visits (visit 1 [1987-1989] and visit 3 [1993-1995]). Dietary calcium and phosphorus intakes were averaged between these 2 visits. Calcification was quantified by the Agatston score in coronary artery, ascending aorta, descending aorta, aortic valve ring, aortic valve, and mitral valve. Results Dietary calcium intake was inversely associated with coronary artery and ascending aorta calcification, whereas the association was not significant for other measures of extra-coronary calcification. For example, the highest vs lowest quartile of calcium intake showed an adjusted OR of 0.66 (95% CI: 0.45-0.98) for coronary artery calcification (Agatston score ≥75th percentile). Dietary phosphorus intake demonstrated similar results, but the magnitude of the association was weaker than dietary calcium intake. Conclusions Dietary calcium and phosphorus intakes at middle age were not positively associated with vascular and valvular calcification at over 75 years old. Our findings did not support the link between a calcium or phosphorus-rich diet and vascular and valvular calcification.
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Affiliation(s)
- Yume Nohara-Shitama
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shoshana H. Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, California, USA
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael J. Blaha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kruczkowska W, Gałęziewska J, Grabowska K, Liese G, Buczek P, Kłosiński KK, Kciuk M, Pasieka Z, Kałuzińska-Kołat Ż, Kołat D. Biomedical Trends in Stimuli-Responsive Hydrogels with Emphasis on Chitosan-Based Formulations. Gels 2024; 10:295. [PMID: 38786212 PMCID: PMC11121652 DOI: 10.3390/gels10050295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Biomedicine is constantly evolving to ensure a significant and positive impact on healthcare, which has resulted in innovative and distinct requisites such as hydrogels. Chitosan-based formulations stand out for their versatile utilization in drug encapsulation, transport, and controlled release, which is complemented by their biocompatibility, biodegradability, and non-immunogenic nature. Stimuli-responsive hydrogels, also known as smart hydrogels, have strictly regulated release patterns since they respond and adapt based on various external stimuli. Moreover, they can imitate the intrinsic tissues' mechanical, biological, and physicochemical properties. These characteristics allow stimuli-responsive hydrogels to provide cutting-edge, effective, and safe treatment. Constant progress in the field necessitates an up-to-date summary of current trends and breakthroughs in the biomedical application of stimuli-responsive chitosan-based hydrogels, which was the aim of this review. General data about hydrogels sensitive to ions, pH, redox potential, light, electric field, temperature, and magnetic field are recapitulated. Additionally, formulations responsive to multiple stimuli are mentioned. Focusing on chitosan-based smart hydrogels, their multifaceted utilization was thoroughly described. The vast application spectrum encompasses neurological disorders, tumors, wound healing, and dermal infections. Available data on smart chitosan hydrogels strongly support the idea that current approaches and developing novel solutions are worth improving. The present paper constitutes a valuable resource for researchers and practitioners in the currently evolving field.
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Affiliation(s)
- Weronika Kruczkowska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Julia Gałęziewska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Katarzyna Grabowska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Gabriela Liese
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Paulina Buczek
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Karol Kamil Kłosiński
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Mateusz Kciuk
- Department of Molecular Biotechnology and Genetics, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland;
| | - Zbigniew Pasieka
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
| | - Żaneta Kałuzińska-Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland
| | - Damian Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (J.G.); (K.G.); (G.L.); (P.B.); (K.K.K.); (Z.P.); (Ż.K.-K.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland
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Li DY, Zhang K, Wang H, Zhuang Y, Zhang BF, Zhang DL. Preoperative Serum Calcium Level Predicts Postoperative Mortality in Older Adult Patients with Hip Fracture: A Prospective Cohort Study of 2333 Patients. J Am Med Dir Assoc 2024; 25:655-660. [PMID: 37660723 DOI: 10.1016/j.jamda.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Hip fractures are a significant cause of mortality among older adults. However, predictive markers for an unfavorable prognosis are still lacking. Serum calcium is an essential element in several biochemical reactions in the body. This study investigated the role of the preoperative serum calcium level as a prognostic parameter for postoperative mortality in older adult patients with hip fractures. DESIGN We conducted a prospective cohort study at the trauma center in our hospital, from January 1, 2015, to September 30, 2019. A total of 2333 older patients with hip fractures were recruited. This prospective cohort study was conducted in accordance with the criteria of STROCSS. SETTING AND PARTICIPANTS Older adult patients with hip fractures were screened between January 2015 and September 2019 at the trauma center of our hospital. METHODS Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative serum calcium level and all-cause mortality. All analyses were performed using EmpowerStats and the R software. RESULTS A total of 2333 older adult patients with hip fractures were included in the study. The mean follow-up was 37.5 months. Overall, 770 patients (33%) died of all causes. The preoperative serum calcium concentrations were 2.18 ± 0.13 mmol/L. Linear multivariate Cox regression models showed that preoperative serum calcium levels were associated with mortality [hazard ratio (HR) 0.37, 95% CI 0.21-0.67; P = .0009] after adjusting for confounders. However, the linear association was unstable, and nonlinearity was identified. A preoperative serum calcium level of 2.3 mmol/L was an inflection point for prediction. When the preoperative serum calcium concentration was below 2.3 mmol/L, serum calcium concentration increased by 1 mmol/L, and mortality risk decreased by 77% (HR 0.23, 95% CI 0.13-0.43, P < .0001). In contrast, when the preoperative serum calcium concentration was more significant than 2.3 mmol/L, the mortality risk increased with serum calcium concentration (HR 6.27, 95% CI 1.65-23.74, P = .0069). CONCLUSIONS AND IMPLICATIONS The preoperative serum calcium level is nonlinearly associated with mortality in older adults with hip fractures, with a U-shaped association, and could be used as a potential predictor of prognosis.
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Affiliation(s)
- Dong-Yang Li
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hu Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Zhuang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Dan-Long Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Cousineau CM, Loftus K, Churchill GA, Bridges D. Cross-sectional association between blood cholesterol and calcium levels in genetically diverse strains of mice. FEBS Open Bio 2024; 14:426-433. [PMID: 38129969 PMCID: PMC10909986 DOI: 10.1002/2211-5463.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Genetically diverse outbred mice allow for the study of genetic variation in the context of high dietary and environmental control. Using a machine learning approach, we investigated clinical and morphometric factors that associate with serum cholesterol levels in 840 genetically unique Diversity Outbred mice of both sexes (n = 417 male and 423 female), and on both a control chow (% kcals in diet: protein 22%, carbohydrate 62%, fat 16%, no cholesterol) and high fat high sucrose (% kcals in diet: protein 15%, carbohydrate 41%, fat 45%, 0.05% cholesterol). We find expected elevations of cholesterol in male mice, as well as in mice with elevated serum triglycerides and/or fed a high fat high sucrose diet. The third strongest predictor was serum calcium which correlated with serum cholesterol across both diets and sexes (r = 0.39-0.48) in both Diversity Outbred (P = 3.0 × 10-43 ) and BXD (P = 0.005) mice. This is in-line with several human cohort studies which show associations between calcium and cholesterol, and calcium as an independent predictor of cardiovascular events.
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Affiliation(s)
- Cody M. Cousineau
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Kaelin Loftus
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | | | - Dave Bridges
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
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5
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Larsson SC, Butterworth AS, Burgess S. Mendelian randomization for cardiovascular diseases: principles and applications. Eur Heart J 2023; 44:4913-4924. [PMID: 37935836 PMCID: PMC10719501 DOI: 10.1093/eurheartj/ehad736] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023] Open
Abstract
Large-scale genome-wide association studies conducted over the last decade have uncovered numerous genetic variants associated with cardiometabolic traits and risk factors. These discoveries have enabled the Mendelian randomization (MR) design, which uses genetic variation as a natural experiment to improve causal inferences from observational data. By analogy with the random assignment of treatment in randomized controlled trials, the random segregation of genetic alleles when DNA is transmitted from parents to offspring at gamete formation is expected to reduce confounding in genetic associations. Mendelian randomization analyses make a set of assumptions that must hold for valid results. Provided that the assumptions are well justified for the genetic variants that are employed as instrumental variables, MR studies can inform on whether a putative risk factor likely has a causal effect on the disease or not. Mendelian randomization has been increasingly applied over recent years to predict the efficacy and safety of existing and novel drugs targeting cardiovascular risk factors and to explore the repurposing potential of available drugs. This review article describes the principles of the MR design and some applications in cardiovascular epidemiology.
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Affiliation(s)
- Susanna C Larsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Wang M, Peng J, Yang C, Zhang W, Cheng Z, Zheng H. Magnesium intake and all-cause mortality after stroke: a cohort study. Nutr J 2023; 22:54. [PMID: 37899441 PMCID: PMC10614364 DOI: 10.1186/s12937-023-00886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/25/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Population-based studies have shown that adequate magnesium intake is associated with a lower risk of stroke and all-cause mortality. Whether adequate magnesium intake is important for reducing all-cause mortality risk after stroke remains unclear. METHODS We analyzed data from 917 patients with a self-reported history of stroke from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The total magnesium intake was calculated by summing the magnesium intake from dietary and dietary supplements, and then adjusting for total energy intake according to the nutrient density method. Mortality status was determined using public-use linked mortality files from 2019. Cox regression model and restricted cubic splines were used to explore the relationship between magnesium intake and all-cause mortality. RESULTS The average total magnesium intake across all patients was 251.0 (184.5-336.5) mg/d, and 321 (70.2%) males and 339 (73.7%) females had insufficient magnesium intake. During a median follow-up period of 5.3 years, 277 deaths occurred. After fully adjusting for confounding factors, total magnesium intake levels were inversely associated with all-cause mortality risk (HR per 1-mg/(100 kcal*d) increase, 0.97; 95% CI, 0.94-1.00; p = 0.017). Participants with the highest quartile of total magnesium intake (≥ 18.5 mg/(100 kcal*d)) had a 40% reduction in all-cause mortality risk compared to those with the lowest quartile (≤ 12.0 mg/(100 kcal*d)) (HR, 0.60; 95% CI, 0.38-0.94; p = 0.024). Stratified analyses showed that this inverse association was statistically significant in those who were older, female, without hypertension, and had smoking, normal renal function, and adequate energy intake. Dietary magnesium intake alone might be not related to all-cause mortality. CONCLUSIONS Stroke survivors who consumed adequate amounts of magnesium from diet and supplements had a lower risk of all-cause mortality.
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Affiliation(s)
- Mengyan Wang
- Department of Neurology, The First People's Hospital of Linhai, Taizhou, 317000, Zhejiang Province, China
| | - Jianhong Peng
- Department of Neurology, The First People's Hospital of Linhai, Taizhou, 317000, Zhejiang Province, China
| | - Caili Yang
- Department of Neurology, The First People's Hospital of Linhai, Taizhou, 317000, Zhejiang Province, China
| | - Wenyuan Zhang
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Zicheng Cheng
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, Zhejiang Province, China.
| | - Haibin Zheng
- Department of Neurology, The First People's Hospital of Linhai, Taizhou, 317000, Zhejiang Province, China.
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Georgiou AN, Zagkos L, Markozannes G, Chalitsios CV, Asimakopoulos AG, Xu W, Wang L, Mesa‐Eguiagaray I, Zhou X, Loizidou EM, Kretsavos N, Theodoratou E, Gill D, Burgess S, Evangelou E, Tsilidis KK, Tzoulaki I. Appraising the Causal Role of Risk Factors in Coronary Artery Disease and Stroke: A Systematic Review of Mendelian Randomization Studies. J Am Heart Assoc 2023; 12:e029040. [PMID: 37804188 PMCID: PMC7615320 DOI: 10.1161/jaha.122.029040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/27/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Mendelian randomization (MR) offers a powerful approach to study potential causal associations between exposures and health outcomes by using genetic variants associated with an exposure as instrumental variables. In this systematic review, we aimed to summarize previous MR studies and to evaluate the evidence for causality for a broad range of exposures in relation to coronary artery disease and stroke. METHODS AND RESULTS MR studies investigating the association of any genetically predicted exposure with coronary artery disease or stroke were identified. Studies were classified into 4 categories built on the significance of the main MR analysis results and its concordance with sensitivity analyses, namely, robust, probable, suggestive, and insufficient. Studies reporting associations that did not perform any sensitivity analysis were classified as nonevaluable. We identified 2725 associations eligible for evaluation, examining 535 distinct exposures. Of them, 141 were classified as robust, 353 as probable, 110 as suggestive, and 926 had insufficient evidence. The most robust associations were observed for anthropometric traits, lipids, and lipoproteins and type 2 diabetes with coronary artery; disease and clinical measurements with coronary artery disease and stroke; and thrombotic factors with stroke. CONCLUSIONS Despite the large number of studies that have been conducted, only a limited number of associations were supported by robust evidence. Approximately half of the studies reporting associations presented an MR sensitivity analysis along with the main analysis that further supported the causality of associations. Future research should focus on more thorough assessments of sensitivity MR analyses and further assessments of mediation effects or nonlinearity of associations.
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Affiliation(s)
- Andrea N. Georgiou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Loukas Zagkos
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Georgios Markozannes
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Christos V. Chalitsios
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | | | - Wei Xu
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | - Lijuan Wang
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | | | - Xuan Zhou
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | - Eleni M. Loizidou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Biobank Cyprus Center of Excellence in Biobanking and Biomedical ResearchUniversity of CyprusNicosiaCyprus
| | - Nikolaos Kretsavos
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Evropi Theodoratou
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and CancerThe University of EdinburghEdinburghUK
| | - Dipender Gill
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - Stephen Burgess
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
- Cardiovascular Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Evangelos Evangelou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Biomedical Research, Institute of Molecular Biology and BiotechnologyFoundation for Research and Technology‐HellasIoanninaGreece
| | - Konstantinos K. Tsilidis
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Centre for Systems Biology, Biomedical Research FoundationAcademy of AthensAthensGreece
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8
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Sim MG, Teo YN, Teo YH, Syn NL, Li TYW, Yeo LLL, Kong WKF, Tan BYQ, Yip JW, Wong RCC, Poh KK, Yeo TC, Sharma VK, Chai P, Chan MY, Sia CH. Association Between Calcium Supplementation and the Risk of Cardiovascular Disease and Stroke: A Systematic Review and Meta-Analysis. Heart Lung Circ 2023; 32:1230-1239. [PMID: 37743221 DOI: 10.1016/j.hlc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Some observational studies and randomised controlled trials (RCTs) have reported an association between calcium supplementation and increased risk of cardiovascular disease. Previous meta-analyses on the topic, based on data from RCTs and observational studies, have contradictory findings. This meta-analysis was conducted to determine the difference in associated risks of calcium supplementation with cardiovascular disease and stroke in RCTs. METHODS Relevant studies published from database inception to 6 August 2021 were sourced from PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. Any RCTs focusing on the relationship between calcium supplementation and incidence of cardiovascular disease or stroke were included. Articles were screened independently by two authors, according to the PICO criteria, with disagreements resolved by a third author. RESULTS Twelve RCTs were included in the meta-analysis. Calcium supplementation was not associated with myocardial infarction, total stroke, heart failure admission, and all-cause/cardiovascular mortality. Subgroup analysis focusing on calcium monotherapy/calcium co-therapy with vitamin D, female sex, follow-up duration, and geographical region did not affect the findings. CONCLUSION Calcium supplementation was not associated with myocardial infarction, total stroke, heart failure admission, and cardiovascular/all-cause mortality. Further studies are required to examine and understand these associations.
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Affiliation(s)
- Ming Gin Sim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://www.twitter.com/yaoneng_teo
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tony Y W Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - William K F Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - James W Yip
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Raymond C C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kian Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Vijay Kumar Sharma
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
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Barreira-Hernández D, Rodríguez-Martín S, Gil M, Mazzucchelli R, Izquierdo-Esteban L, García-Lledó A, Pérez-Gómez A, Rodríguez-Miguel A, de Abajo FJ. Risk of Ischemic Stroke Associated with Calcium Supplements and Interaction with Oral Bisphosphonates: A Nested Case-Control Study. J Clin Med 2023; 12:5294. [PMID: 37629338 PMCID: PMC10455805 DOI: 10.3390/jcm12165294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Conflicting results about the association of calcium supplements (CS) with ischemic stroke (IS) have been reported. We tested this hypothesis by differentiating between CS alone (CaM) and CS with vitamin D (CaD) and between cardioembolic and non-cardioembolic IS. We examined the potential interaction with oral bisphosphonates (oBs). A nested case-control study was carried out. We identified incident IS cases aged 40-90 and randomly sampled five controls per case matched by age, sex, and index date. Current users were compared to non-users. An adjusted odds ratios (AOR) and 95% CI were computed through conditional logistic regression. Only new users were considered. We included 13,267 cases (4400 cardioembolic, 8867 non-cardioembolic) and 61,378 controls (20,147 and 41,231, respectively). CaM use was associated with an increased risk of cardioembolic IS (AOR = 1.88; 95% CI: 1.21-2.90) in a duration-dependent manner, while it showed no association with non-cardioembolic IS (AOR = 1.05; 95% CI: 0.74-1.50); its combination with oBs increased the risk of cardioembolic IS considerably (AOR = 2.54; 95% CI: 1.28-5.04), showing no effect on non-cardioembolic. CaD use was not associated with either cardioembolic (AOR = 1.08; 95% CI: 0.88-1.31) or non-cardioembolic IS (AOR = 0.98; 95% CI: 0.84-1.13) but showed a small association with cardioembolic IS when combined with oBs (AOR = 1.35; 95% CI: 1.03-1.76). The results support the hypothesis that CS increases the risk of cardioembolic IS, primarily when used concomitantly with oBs.
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Affiliation(s)
- Diana Barreira-Hernández
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
| | - Sara Rodríguez-Martín
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
| | - Miguel Gil
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency on Medicines and Medical Devices (AEMPS), 28022 Madrid, Spain;
| | - Ramón Mazzucchelli
- Rheumatology Department, University Hospital “Fundación Alcorcón”, 28922 Alcorcón, Spain;
| | - Laura Izquierdo-Esteban
- Stroke Unit, Department of Neurology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain;
| | - Alberto García-Lledó
- Department of Cardiology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain;
- Department of Medicine, University of Alcalá, 28805 Alcalá de Henares, Spain;
| | - Ana Pérez-Gómez
- Department of Medicine, University of Alcalá, 28805 Alcalá de Henares, Spain;
- Department of Rheumatology, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain
| | - Antonio Rodríguez-Miguel
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
| | - Francisco J. de Abajo
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Alcalá de Henares, Spain; (D.B.-H.); (S.R.-M.); (A.R.-M.)
- Clinical Pharmacology Unit, University Hospital “Príncipe de Asturias”, 28805 Alcalá de Henares, Spain
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10
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Yang JH, Kweon SS, Lee YH, Choi SW, Ryu SY, Nam HS, Kim HY, Shin MH. Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults. J Prev Med Public Health 2023; 56:282-290. [PMID: 37287206 DOI: 10.3961/jpmph.23.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality. METHODS This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: <2.5th, 2.5-25.0th, 25.0-50.0th, 50.0-75.0th, 75.0-97.5th, and >97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate. RESULTS Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (<2.5th: HR, 6.23; 95% confidence interval [CI], 1.16 to 33.56; >97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (<2.5th: HR, 1.37; 95% CI, 0.58 to 3.27; >97.5th: HR, 1.65; 95% CI, 0.70 to 3.93). CONCLUSIONS We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.
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Affiliation(s)
- Jung-Ho Yang
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang School of Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hye-Yeon Kim
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
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11
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Yang M, Miao J, Du L, Wang J, Yang J, Lu J, Fan X, Huang C, Fu Z, Xu Z, Song M, Ma H, Jin G, Hu Z, Hang D, Shen H. Serum calcium concentrations and risk of all-cause and cause-specific mortality: results from two prospective cohorts. J Clin Endocrinol Metab 2023:7046139. [PMID: 36806939 DOI: 10.1210/clinem/dgad078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/20/2023]
Abstract
CONTEXT Calcium plays a critical role in various physiological activities. However, the association between circulating calcium concentrations and mortality in a general healthy population remains undetermined. OBJECTIVE To examine the association of serum calcium concentrations with all-cause and cause-specific mortality. METHODS Leveraging data from the UK Biobank (n=361 662) and the US National Health and Nutrition Examination Survey (NHANES, n=36 985), we prospectively examined the association of serum calcium concentrations with all-cause and cause-specific mortality using Cox proportional hazard and restricted-cubic spline models. RESULTS During a median follow-up of 12.0 years, UK Biobank documented 18 327 deaths, including 3119 (17.0%) from cardiovascular disease (CVD) and 9599 (52.4%) from cancer. We found a U-shape relationship of albumin-adjusted calcium concentrations with all-cause and CVD mortality. Compared to participants with moderate calcium levels (the third quintile, Q3), those with low and high levels had an increased risk of all-cause (hazard ratio [HR]=1.02 for Q1 vs. Q3; 1.10 for Q5 vs. Q3) and CVD mortality (HR=1.11 for Q1 vs. Q3; 1.25 for Q5 vs. Q3). In contrast, there was a linear positive relationship with cancer mortality (HR=1.09 for Q5 vs. Q1). Similar results for all-cause, CVD, and cancer mortality were observed in US NHANES. CONCLUSIONS Our findings provide novel insights into the association between serum calcium concentrations and mortality in the general healthy population.
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Affiliation(s)
- Mingjia Yang
- Department of Epidemiology, School of Public Health, Southeast University, Nanjing 210009, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Junyan Miao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Lingbin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jiayu Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jing Yang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jiayi Lu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xikang Fan
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Changzhi Huang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zan Fu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Guangfu Jin
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Zhibin Hu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Dong Hang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Southeast University, Nanjing 210009, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School, Nanjing Medical University 211166, Nanjing, China
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12
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Cousineau CM, Loftus K, Churchill GA, Bridges D. Cross-sectional association between blood cholesterol and calcium levels in genetically diverse strains of mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.08.527123. [PMID: 36798159 PMCID: PMC9934644 DOI: 10.1101/2023.02.08.527123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Genetically diverse outbred mice allow for the study of genetic variation in the context of high dietary and environmental control. Using a machine learning approach we investigated clinical and morphometric factors that associate with serum cholesterol levels in 840 genetically unique mice of both sexes, and on both a control chow and high fat high sucrose diet. We find expected elevations of cholesterol in male mice, those with elevated serum triglycerides and/or fed a high fat high sucrose diet. The third strongest predictor was serum calcium which correlated with serum cholesterol across both diets and sexes (r=0.39-0.48). This is in-line with several human cohort studies which show associations between calcium and cholesterol, and calcium as an independent predictor of cardiovascular events.
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Affiliation(s)
- Cody M. Cousineau
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | - Kaelin Loftus
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | | | - Dave Bridges
- Department of Nutritional Sciences, University of Michigan School of Public Health
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13
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Ni X, Liu L, Yao Y, Zhang C, Su H, Lv Y, Li R, Sun L, Zhou Q, Zhu X, Yang Z, Chen Z, He W, Zhu H, Zhang S, Hu C, Yuan H. The genetic correlation and causal association between key factors that influence vascular calcification and cardiovascular disease incidence. Front Cardiovasc Med 2023; 10:1096662. [PMID: 36776247 PMCID: PMC9908996 DOI: 10.3389/fcvm.2023.1096662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Background Serum calcium (Ca), vitamin D (VD), and vitamin K (VK) levels are key determinants of vascular calcification, which itself impacts cardiovascular disease (CVD) risk. The specific relationships between the levels of these different compounds and particular forms of CVD, however, remain to be fully defined. Objective This study was designed to explore the associations between these serum levels and CVDs with the goal of identifying natural interventions capable of controlling vascular calcification and thereby protecting against CVD pathogenesis, extending the healthy lifespan of at-risk individuals. Methods Linkage disequilibrium score (LDSC) regression and a two-sample Mendelian randomization (MR) framework were leveraged to systematically examine the causal interplay between these serum levels and nine forms of CVD, as well as longevity through the use of large publically accessible Genome-Wide Association Studies (GWAS) datasets. The optimal concentrations of serum Ca and VD to lower CVD risk were examined through a restrictive cubic spline (RCS) approach. Results After Bonferroni correction, the positive genetic correlations were observed between serum Ca levels and myocardial infarction (MI) (p = 1.356E-04), as well as coronary artery disease (CAD) (p = 3.601E-04). Negative genetic correlations were detected between levels of VD and CAD (p = 0.035), while elevated VK1 concentrations were causally associated with heart failure (HF) [odds ratios (OR) per 1-standard deviation (SD) increase: 1.044], large artery stroke (LAS) (OR per 1-SD increase: 1.172), and all stroke (AS) (OR per 1-SD increase: 1.041). Higher serum Ca concentrations (OR per 1-SD increase: 0.865) and VD levels (OR per 1-SD increase: 0.777) were causally associated with reduced odds of longevity. These findings remained consistent in sensitivity analyses, and serum Ca and VD concentrations of 2.376 mmol/L and 46.8 nmol/L, respectively, were associated with a lower CVD risk (p < 0.001). Conclusion Our findings support a genetic correlation between serum Ca and VD and CVD risk, and a causal relationship between VK1 levels and CVD risk. The optimal serum Ca (2.376 mmol/L) and VD levels (46.8 nmol/L) can reduce cardiovascular risk.
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Affiliation(s)
- Xiaolin Ni
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China,State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Lei Liu
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | | | - Yuan Lv
- Jiangbin Hospital, Zhenjiang, China
| | | | - Liang Sun
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Qi Zhou
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Xiaoquan Zhu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Ze Yang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Zuoguan Chen
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China
| | - Wei He
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Huolan Zhu
- Department of Geriatrics, Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Shenqi Zhang
- Department of Joint and Sports Medicine, Zaozhuang Municipal Hospital Affiliated to Jining Medical University, Zaozhuang, Shandong, China
| | - Caiyou Hu
- Jiangbin Hospital, Zhenjiang, China,Caiyou Hu,
| | - Huiping Yuan
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China,*Correspondence: Huiping Yuan,
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14
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Hou X, Hu J, Liu Z, Wang E, Guo Q, Zhang Z, Song Z. L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study. Front Nutr 2023; 9:1097488. [PMID: 36687714 PMCID: PMC9849810 DOI: 10.3389/fnut.2022.1097488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Calcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated. Methods This prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999-2018). All-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality were obtained through linkage to the National Death Index. Survey-weighted multivariate Cox regression was performed to compute hazard ratios (HRs) and 95% confidential intervals (CIs) for the associations of calcium levels with risks of mortality. Restricted cubic spline analyses were performed to examine the non-linear association of calcium levels with all-cause and disease-specific mortality. Results A total of 51,042 individuals were included in the current study. During an average of 9.7 years of follow-up, 7,592 all-cause deaths were identified, including 2,391 CVD deaths and 1,641 cancer deaths. Compared with participants in the first quartile (Q1) of serum calcium level [≤2.299 mmol/L], the risk of all-cause mortality was lower for participants in the second quartile (Q2) [2.300-2.349 mmol/L], the third quartile (Q3) [2.350-2.424 mmol/L] and the fourth quartile (Q4) [≥2.425 mmol/L] with multivariable-adjusted HRs of 0.81 (95% CI, 0.74-0.88), 0.78 (95% CI, 0.71-0.86), and 0.80 (95% CI, 0.73, 0.88). Similar associations were observed for CVD mortality, with HRs of 0.82 (95% CI, 0.71-0.95), 0.87 (95% CI, 0.74-1.02), and 0.83 (95% CI, 0.72, 0.97) in Q2-Q4 quartile. Furthermore, the L-shaped non-linear associations were detected for serum calcium with the risk of all-cause mortality. Below the median of 2.350 mmol/L, per 0.1 mmol/L higher serum calcium was associated with a 24% lower risk of all-cause mortality (HR: 0.76, 95% CI, 0.70-0.83), however, no significant changes were observed when serum calcium was above the median. Similar L-shaped associations were detected for serum calcium with the risk of CVD mortality with a 25% reduction in the risk of CVD death per 0.1 mmol/L higher serum calcium below the median (HR: 0.75, 95% CI, 0.65-0.86). Conclusion L-shaped associations of serum calcium with all-cause and CVD mortality were observed in US adults, and hypocalcemia was associated with a higher risk of all-cause mortality and CVD mortality.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuoyi Liu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - E. Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhong Zhang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Zongbin Song,
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15
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Shishkova D, Lobov A, Zainullina B, Matveeva V, Markova V, Sinitskaya A, Velikanova E, Sinitsky M, Kanonykina A, Dyleva Y, Kutikhin A. Calciprotein Particles Cause Physiologically Significant Pro-Inflammatory Response in Endothelial Cells and Systemic Circulation. Int J Mol Sci 2022; 23:ijms232314941. [PMID: 36499266 PMCID: PMC9738209 DOI: 10.3390/ijms232314941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Calciprotein particles (CPPs) represent an inherent mineral buffering system responsible for the scavenging of excessive Ca2+ and PO43- ions in order to prevent extraskeletal calcification, although contributing to the development of endothelial dysfunction during the circulation in the bloodstream. Here, we performed label-free proteomic profiling to identify the functional consequences of CPP internalisation by endothelial cells (ECs) and found molecular signatures of significant disturbances in mitochondrial and lysosomal physiology, including oxidative stress, vacuolar acidification, accelerated proteolysis, Ca2+ cytosolic elevation, and mitochondrial outer membrane permeabilisation. Incubation of intact ECs with conditioned medium from CPP-treated ECs caused their pro-inflammatory activation manifested by vascular cell adhesion molecule 1 (VCAM1) and intercellular adhesion molecule 1 (ICAM1) upregulation and elevated release of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1/ C-C motif ligand 2 (MCP-1/CCL2). Among the blood cells, monocytes were exclusively responsible for CPP internalisation. As compared to the co-incubation of donor blood with CPPs in the flow culture system, intravenous administration of CPPs to Wistar rats caused a considerably higher production of chemokines, indicating the major role of monocytes in CPP-triggered inflammation. Upregulation of sICAM-1 and IL-8 also suggested a notable contribution of endothelial dysfunction to systemic inflammatory response after CPP injections. Collectively, our results demonstrate the pathophysiological significance of CPPs and highlight the need for the development of anti-CPP therapies.
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Affiliation(s)
- Daria Shishkova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Arseniy Lobov
- Laboratory of Regenerative Biomedicine, Institute of Cytology of the RAS, 4 Tikhoretskiy Prospekt, 194064 St. Petersburg, Russia
| | - Bozhana Zainullina
- Centre for Molecular and Cell Technologies, St. Petersburg State University, Universitetskaya Embankment, 7/9, 199034 St. Petersburg, Russia
| | - Vera Matveeva
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Victoria Markova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anna Sinitskaya
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Elena Velikanova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Maxim Sinitsky
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anastasia Kanonykina
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Yulia Dyleva
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anton Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
- Correspondence: ; Tel.: +7-960-907-7067
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16
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Reid IR. EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: Osteoporosis management. Eur J Endocrinol 2022; 187:R65-R80. [PMID: 35984345 DOI: 10.1530/eje-22-0574] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
Fractures occur in about half of older White women, and almost a third of older White men. However, 80% of the older individuals who have fractures do not meet the bone density definition of osteoporosis, suggesting that this definition is not an appropriate threshold for offering treatment. Fracture risk can be estimated based on clinical risk factors with or without bone density. A combination of calculated risk, fracture history, and bone density is used in treatment decisions. Medications available for reducing fracture risk act either to inhibit bone resorption or to promote bone formation. Romosozumab is unique in that it has both activities. Bisphosphonates are the most widely used interventions because of their efficacy, safety, and low cost. Continuous use of oral bisphosphonates for >5 years increases the risk of atypical femoral fractures, so is usually punctuated with drug holidays of 6-24 months. Denosumab is a further potent anti-resorptive agent given as 6-monthly s.c. injections. It is comparable to the bisphosphonates in efficacy and safety but has a rapid offset of effect after discontinuation so must be followed by an alternative drug, usually a bisphosphonate. Teriparatide stimulates both bone formation and resorption, substantially increases spine density, and reduces vertebral and non-vertebral fracture rates, though data for hip fractures are scant. Treatment is usually limited to 18-24 months, followed by the transition to an anti-resorptive. Romosozumab is given as monthly s.c. injections for 1 year, followed by an anti-resorptive. This sequence prevents more fractures than anti-resorptive therapy alone. Because of cost, anabolic drugs are usually reserved for those at very high fracture risk. 25-hydroxyvitamin D levels should be maintained above 30 nmol/L, using supplements if sunlight exposure is limited. Calcium intake has little effect on bone density and fracture risk but should be maintained above 500 mg/day using dietary sources.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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The synergy between diurnal temperature range and calcium concentration help to predict hospital mortality in patients with acute myocardial infarction. Sci Rep 2022; 12:15527. [PMID: 36109534 PMCID: PMC9477801 DOI: 10.1038/s41598-022-18816-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/19/2022] [Indexed: 11/09/2022] Open
Abstract
Epidemiological studies have suggested that cold is an important contributor to acute cardiovascular events and mortality. However, little is known about the Diurnal Temperature Range (DTR) impact on mortality of the patients with myocardial infarction. Calcium ions (Ca2+) play a vital role in the human body, such as cardiac electrophysiology and contraction. To investigate whether DTR on admission moderates the association between serum calcium and in-hospital mortality in patients with acute myocardial infarction (AMI). This retrospective study enrolled consecutive adult patients with AMI at a single center in China (2003–2012). Patients were divided into four groups (Ca-Q1–4) according to serum calcium concentration quartiles. Multivariate logistic regression modeling was used to assess whether DTR moderated the association between serum calcium and in-hospital mortality. The predictive value of serum calcium was evaluated by receiver operating characteristic (ROC) curve and net reclassification improvement (NRI) analyses. The study included 3780 patients. In-hospital mortality was 4.97% (188/3780). DTR moderated the association between serum calcium and in-hospital mortality (P-interaction = 0.020). Patients with low serum calcium in the highest DTR quartile exhibited an increased risk of in-hospital mortality (odds ratio for Ca-Q4 vs. Ca-Q1, 0.03; 95% confidence interval [95% CI], 0.01–0.20). In the highest DTR quartile, adding serum calcium concentration to the risk factor model increased the area under the ROC curve (0.81 vs. 0.76; P < 0.001) and increased NRI by 20.2% (95% CI 7.5–32.9; P = 0.001). Low serum calcium was an independent risk factor for in-hospital mortality in patients with AMI, and this association was moderated by DTR. Careful attention should be paid to patients with low serum calcium who experience a higher DTR on admission.
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Cao W, Li Y, Wen Y, Fang S, Zhao B, Zhang X, Zhang Y, Lang X, Yu B, Zhang Y. Higher serum phosphorus and calcium levels provide prognostic value in patients with acute myocardial infarction. Front Cardiovasc Med 2022; 9:929634. [PMID: 36158790 PMCID: PMC9489914 DOI: 10.3389/fcvm.2022.929634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Although traditional cardiovascular risk factors are closely related to the poor prognosis of acute myocardial infarction (AMI) patients, there are few studies on the relationship of serum phosphorus and calcium with prognosis in AMI patients. The relationship of serum phosphorus and calcium with prognostic biomarkers in AMI remains unclear. Methods and results A total of 3,891 AMI patients were enrolled from a prospective cohort study. We investigated the association of serum phosphorus and calcium with prognostic biomarkers. The risk of in-hospital heart failure (HF), post-discharge HF, all-cause mortality and cardiac mortality was estimated across quartiles of serum phosphorus and calcium levels. Serum phosphorus and calcium levels were associated with biomarkers of prognosis. Overall, 969 patients developed in-hospital HF during hospitalization, 549 patients developed post-discharge HF during a median follow-up of 12 months, and 252 patients died, with 170 cardiac deaths since admission. In the fully adjusted model, compared with patients in quartile 2 (Q2), patients with serum phosphorus levels in Q4 were at greater risk of post-discharge HF [sub-distributional hazard ratios (SHR) 1.55; 95% confidence interval (CI), 1.21–1.99], in-hospital HF [odds ratio (OR) 1.84; 95% CI, 1.47–2.31], all-cause mortality (HR 1.59; 95% CI, 1.08–2.32), and cardiac mortality (SHR 1.68; 95% CI, 1.03–2.75). Compared with patients in Q2, patients with corrected calcium levels in Q4 had a higher risk of in-hospital HF (OR 1.62; 95% CI, 1.29–2.04), all-cause mortality (HR 1.99; 95% CI, 1.37–2.88), and cardiac mortality (SHR 1.87; 95% CI, 1.19–2.96; all p-trend < 0.05). Conclusion Serum phosphorus and calcium levels were associated with AMI prognostic biomarkers in AMI. Higher serum phosphorus was independently related to the increased risk of in-hospital HF, postdischarge HF, all-cause mortality and cardiac mortality, and higher serum calcium was independently related to the increased risk of in-hospital HF, all-cause mortality and cardiac mortality after AMI.
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Affiliation(s)
- Wei Cao
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, China
| | - Yilan Li
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Yao Wen
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shaohong Fang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bing Zhao
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xiaoyuan Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Yanxiu Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Xueyan Lang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
- Bo Yu
| | - Yao Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
- *Correspondence: Yao Zhang
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Ding C, Bi C, Lin T, Liu L, Song Y, Wang B, Wang P, Fang C, Ma H, Huang X, Xu X, Zhang H, Hu L, Huo Y, Wang X, Bao H, Cheng X. Association between serum calcium levels and first stroke: A community-based nested case-control study. Front Neurol 2022; 13:938794. [PMID: 35989922 PMCID: PMC9388910 DOI: 10.3389/fneur.2022.938794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence from epidemiologic studies has been limited and inconsistent regarding the role of serum calcium in stroke incidence risk. We aimed to evaluate the association between serum albumin-corrected calcium and the risk of the first stroke in the Chinese community-dwelling population. Methods The study sample population was drawn from the “H-type Hypertension and Stroke Prevention and Control Project.” Using a nested case-control study, a total of 1,255 first-stroke cases and 1,255 controls matched for age, sex, and village were included in the final data analysis. We measured the serum calcium by inductively coupled plasma mass spectrometry and assessed the associations between serum albumin-corrected calcium and first stroke using conditional logistic regression. Results The overall mean (SD) serum albumin-corrected calcium was 8.9 (0.6) mg/dl. Compared with the middle tertile (8.7–9.1 mg/dl), the multivariate-adjusted odds ratios (95% CIs) of first total stroke associated with the lowest tertile and the highest tertile of serum albumin-corrected calcium were 1.37 (1.10, 1.70) and 1.30 (1.04, 1.62), respectively. Similar trends were observed for the first ischemic stroke. Consistently, restricted cubic spline showed a U-shaped association between serum albumin-corrected calcium and risk of total stroke and ischemic stroke. However, serum albumin-corrected calcium had no significant effect on first hemorrhagic stroke. No significant effect modification was observed in the subgroup analysis. Conclusions Our results suggested a U-shaped association between serum calcium and first stroke; both low and high serum calcium levels were associated with an increased risk of the first stroke in the Chinese population.
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Affiliation(s)
- Congcong Ding
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chonglei Bi
- People's Hospital of Rongcheng, Rongcheng, China
| | - Tengfei Lin
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
- Department of Research, Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Ping Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | | | - Hai Ma
- Health and Family Planning Commission, Rongcheng, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Hao Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Huihui Bao
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Xiaoshu Cheng
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Woo JS, Woo Y, Jang JY, Ha SJ. Effect of vitamin D on endothelial and ventricular function in chronic heart failure patients: A prospective, randomized, placebo-controlled trial. Medicine (Baltimore) 2022; 101:e29623. [PMID: 35866799 PMCID: PMC9302363 DOI: 10.1097/md.0000000000029623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Low 25-hydroxyvitamin D (25OHD) levels are common in patients with chronic heart failure (HF) and are associated with increased mortality risk. This study aimed to establish the safety and efficacy of oral vitamin D3 (cholecalciferol) supplementation and its effect on endothelial and ventricular function in patients with stable HF. METHODS This study was an investigator-initiated, multicenter, prospective, randomized, placebo-controlled trial. Seventy-three HF patients with 25OHD levels < 75 nmol/L (30 ng/mL) were randomized to receive 4000 IU vitamin D daily or a placebo for 6 months. The primary endpoint was a change in endothelial function between the baseline and after 6 months as assessed using EndoPAT. Secondary endpoints included changes in echocardiographic parameters and differences in quality of life (6-min walking test and New York Heart Association functional status) at 6 months. RESULTS There were no adverse events in either group during the study period. Vitamin D supplementation did not improve endothelial dysfunction (EndoPAT: baseline, 1.19 ± 0.4 vs 6 months later, 1.22 ± 0.3, P = .65). However, patients' blood pressure, 6-min walking distance, and EQ-5D questionnaire scores improved after vitamin D treatment. In addition, a significant reduction in the left atrial diameter was observed. CONCLUSION A daily vitamin D dose of 4000 IU for chronic HF appears to be safe. This dosage did not improve endothelial function but did improve the 6-min walk distance, symptoms, and left atrial diameter at 6 months.
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Affiliation(s)
- Jong Shin Woo
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Yeongmin Woo
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jeong Yoon Jang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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Yun K, Zhang S, Yang X, Man D, Yao J, Wang W, Han X. Corrected Serum Ionized Calcium as a Risk Factor Related to Adult Dyslipidemia. Front Cardiovasc Med 2022; 9:916991. [PMID: 35872922 PMCID: PMC9299357 DOI: 10.3389/fcvm.2022.916991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dyslipidemia is a significant threat to global public health due to its pivotal role as a cardiovascular disease (CVD) risk factor. Calcium is a critical nutritional element required for electrical signal transduction and muscle and heart function, and calcium supplementation is widespread in the general population. However, associations between serum calcium and serum lipid profiles remain conflicting. Considering ionized calcium [Ca(2+)] is the best measure of active serum calcium and the lack of Ca(2+) analyzers, we aimed to examine the independent and joint associations between serum ionized calcium corrected by albumin ([Ca2+]corr) and the known modifiable risk factors and dyslipidemia. Methods We collected physical examination records, including demographic, anthropometric, laboratory tests, and clinical characteristics from individuals who had health checkups in 2019 at the health examination center of the First Affiliated Hospital of China Medical University. Subjects were categorized into Q1–Q4 groups using [Ca2+]corr quartiles, and odds ratios (ORs) with 95% confidence intervals (CIs) for dyslipidemia and associated components were calculated using logistic regression. We also performed non-linear and threshold effect analyses of [Ca2+]corr and triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (Non-HDL-C) levels. Findings Of 5,416 individuals aged 18–92 years, multivariable-adjusted models showed that ORs for dyslipidemia increased gradually with elevated [Ca2+]corr levels. Logistic regression analyses demonstrated that [Ca2+]corr levels were associated with the increased odds of dyslipidemia (per 1 mmol/L increase: OR = 3.53, 95% CI: 1.56–8.00, P < 0.001). When compared with individuals in the Q1 group, those in groups Q3 and Q4 had significantly higher dyslipidemia odds (ORQ3 vs. Q1 = 1.20, 95% CI: 1.01–1.42; ORQ4 vs. Q1 = 1.31, 95% CI: 1.10–1.56, all P < 0.05). Furthermore, a linear, positive relationship between [Ca2+]corr levels and dyslipidemia odds was observed (P for non-linear trend = 0.506), and the optimal cut-off point of [Ca2+]corr for dyslipidemia management was 2.26 mmol/L. A modifiable effect of albumin on the relationship between [Ca2+]corr and dyslipidemia odds was also found (P for interaction = 0.014). High [Ca2+]corr levels were positively associated with elevated TC, LDL-C, and Non-HDL-C but inversely associated with decreased HDL-C odds. Moreover, Locally weighted regression (Loess) analyses showed a non-linear, positive relationship between [Ca2+]corr and TG, TC, HDL-C, LDL-C, and Non-HDL-C levels. Interpretation Corrected serum ionized calcium was positively associated with increased odds of dyslipidemia and elevated TC, LDL-C, and Non-HDL-C, but inversely associated with the odds of decreased HDL-C.
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Affiliation(s)
- Ke Yun
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shuang Zhang
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Units of Medical Laboratory, Chinese Academy of Medical Sciences, Shenyang, China
- NHC Key Laboratory of AIDS Immunology, China Medical University, Shenyang, China
| | - Xiaotao Yang
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dongliang Man
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jialiang Yao
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Physical Examination Center, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Wei Wang,
| | - Xiaoxu Han
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
- Units of Medical Laboratory, Chinese Academy of Medical Sciences, Shenyang, China
- NHC Key Laboratory of AIDS Immunology, China Medical University, Shenyang, China
- Xiaoxu Han,
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22
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Kobylecki CJ, Nordestgaard BG, Afzal S. Low Plasma Ionized Calcium Is Associated With Increased Mortality: A Population-based Study of 106 768 Individuals. J Clin Endocrinol Metab 2022; 107:e3039-e3047. [PMID: 35276011 DOI: 10.1210/clinem/dgac146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Low circulating total calcium or albumin-adjusted calcium has been associated with higher mortality, especially in hospital settings; however, these measures tend to misclassify patients with derangements in calcium homeostasis. OBJECTIVE As the association of the biologically active ionized calcium with mortality is poorly elucidated, we tested the hypothesis that low plasma ionized calcium is associated with higher risk of all-cause and cause-specific mortality in the general population. METHODS We included 106 768 individuals from the Copenhagen General Population Study. Information on all-cause and cause-specific mortality was from registries and risks were calculated using Cox regression and competing-risks regression by the STATA command stcompet. RESULTS During a median follow-up period of 9.2 years, 11 269 individuals died. Each 0.1 mmol/L lower plasma ionized calcium below the median of 1.21 mmol/L was associated with a multivariable adjusted hazard ratio of 1.23 (95% CI, 1.10-1.38) for all-cause mortality. Corresponding hazard ratios for cancer and other mortality were 1.29 (1.06-1.57) and 1.24 (1.01-1.53), respectively. In contrast, for cardiovascular mortality, only high plasma ionized calcium was associated with mortality with a hazard ratio of 1.17 (1.02-1.35) per 0.1 mmol/L higher plasma ionized calcium above the median. We found no interactions between plasma ionized calcium and preexisting cardiovascular or renal disease on all-cause mortality. CONCLUSION In the general population, low plasma ionized calcium was associated with increased all-cause, cancer, and other mortality, while high levels were associated with increased cardiovascular mortality.
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Affiliation(s)
- Camilla J Kobylecki
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lu Y, Ma X, Tazmini K, Yang M, Zhou X, Wang Y. Admission Serum Calcium Level and Short-Term Mortality After Acute Ischemic Stroke: A Secondary Analysis Based on a Norwegian Retrospective Cohort. Front Neurol 2022; 13:889518. [PMID: 35785360 PMCID: PMC9240666 DOI: 10.3389/fneur.2022.889518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDisturbed serum calcium levels are related to the risk of stroke. However, previous studies exploring the correlation between serum calcium and the clinical outcome of ischemic stroke (IS) have shown inconsistent results.ObjectThe study aimed to investigate the relationship between admission serum calcium and 30-day mortality in patients with IS.MethodsA total of 876 IS patients from a Norwegian retrospective cohort were included for secondary analysis. The exposure variable and the primary outcome were albumin-corrected serum calcium (ACSC) at baseline and all-cause mortality within 30 days after the first admission, respectively. Multivariable logistic regression analysis was used to estimate the risk of 30-day mortality according to ACSC levels. Moreover, the potential presence of a non-linear relationship was evaluated using two-piecewise linear regression with a smoothing function and threshold level analysis. The stability of the results was evaluated by unadjusted and adjusted models.ResultsThe result of multiple regression analysis showed that ACSC at baseline was positively associated with the incidence of 30-day mortality after adjusting for the potential confounders (age, gender, serum glucose, hypertension, atrial fibrillation/atrial flutter, renal insufficiency, heart failure, chronic obstructive pulmonary disease, pneumonia, paralysis, and aphasia) (OR = 2.43, 95% CI 1.43–4.12). When ACSC was translated into a categorical variable, the ORs and 95% CIs in the second to the fourth quartile vs. the first quartile were 1.23 (0.56, 2.69), 1.16 (0.51, 2.65), and 2.13 (1.04, 4.38), respectively (P for trend = 0.03). Moreover, the results of two-piecewise linear regression and curve-fitting revealed a linear relationship between ACSC and 30-day mortality.ConclusionACSC is positively associated with 30-day mortality in IS patients, and the relationship between them is linear.
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Affiliation(s)
- Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Xin Ma
- Department of Thoracic Surgery, Jingshan Union Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Kiarash Tazmini
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
| | - Ming Yang
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, Wuhan, China
- *Correspondence: Ming Yang
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
- Xiaobing Zhou
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Yang Wang
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Effectiveness of a Nutritional Mobile Application for Management of Hyperphosphatemia in Patients on Hemodialysis: A Multicenter Open-Label Randomized Clinical Trial. J Pers Med 2022; 12:jpm12060961. [PMID: 35743746 PMCID: PMC9224811 DOI: 10.3390/jpm12060961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
This study aims to determine the effectiveness of a phosphate mobile app (PMA), MyKidneyDiet-Phosphate Tracker ©2019, on hemodialysis (HD) patients with hyperphosphatemia. A multicenter, open-label, randomized controlled trial design allowed randomization of patients with hyperphosphatemia to either the usual care group (UG; receiving a single dietitian-led session with an education booklet) or the PMA group (PG). Thirty-three patients in each intervention group completed the 12-week study. Post-intervention, serum phosphorus levels were reduced in both groups (PG: −0.25 ± 0.42 mmol/L, p = 0.001; UG: −0.23 ± 0.33 mmol/L, p < 0.001) without any treatment difference (p > 0.05). Patients in both groups increased their phosphate knowledge (PG: 2.18 ± 3.40, p = 0.001; UG: 2.50 ± 4.50, p = 0.003), without any treatment difference (p > 0.05). Dietary phosphorus intake of both groups was reduced (PG: −188.1 ± 161.3 mg/d, p < 0.001; UG: −266.0 ± 193.3 mg/d, p < 0.001), without any treatment difference (p > 0.05). The serum calcium levels of patients in the UG group increased significantly (0.09 ± 0.20 mmol/L, p = 0.013) but not for the PG group (−0.03 ± 0.13 mmol/L, p = 0.386), and the treatment difference was significant (p = 0.007). As per phosphate binder adherence, both groups reported a significant increase in Morisky Medication Adherence Scale scores (PG: 1.1 ± 1.2, p < 0.001; UGa: 0.8 ± 1.5, p = 0.007), without any treatment difference (p > 0.05). HD patients with hyperphosphatemia using the PMA achieved reductions in serum phosphorus levels and dietary phosphorus intakes along with improved phosphate knowledge and phosphate binder adherence that were not significantly different from a one-off dietitian intervention. However, binder dose adjustment with meal phosphate content facilitated by the PMA allowed stability of corrected calcium levels, which was not attained by UC patients whose binder dose was fixed.
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Pretorius M, Lundstam K, Heck A, Fagerland MW, Godang K, Mollerup C, Fougner SL, Pernow Y, Aas T, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J. Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation. Ann Intern Med 2022; 175:812-819. [PMID: 35436153 DOI: 10.7326/m21-4416] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with increased risk for fractures, cardiovascular disease, kidney disease, and cancer and increased mortality. In mild PHPT with modest hypercalcemia and without known morbidities, parathyroidectomy (PTX) is debated because no long-term randomized trials have been performed. OBJECTIVE To examine the effect of PTX on mild PHPT with regard to mortality (primary end point) and key morbidities (secondary end point). DESIGN Prospective randomized controlled trial. (ClinicalTrials.gov: NCT00522028). SETTING Eight Scandinavian referral centers. PATIENTS From 1998 to 2005, 191 patients with mild PHPT were included. INTERVENTION Ninety-five patients were randomly assigned to PTX, and 96 were assigned to observation without intervention (OBS). MEASUREMENTS Date and causes of death were obtained from the Swedish and Norwegian Cause of Death Registries 10 years after randomization and after an extended observation period lasting until 2018. Morbidity events were prospectively registered annually. RESULTS After 10 years, 15 patients had died (8 in the PTX group and 7 in the OBS group). Within the extended observation period, 44 deaths occurred, which were evenly distributed between groups (24 in the PTX group and 20 in the OBS group). A total of 101 morbidity events (cardiovascular events, cerebrovascular events, cancer, peripheral fractures, and renal stones) were also similarly distributed between groups (52 in the PTX group and 49 in the OBS group). During the study, a total of 16 vertebral fractures occurred in 14 patients (7 in each group). LIMITATION During the study period, 23 patients in the PTX group and 27 in the OBS group withdrew. CONCLUSION Parathyroidectomy does not appear to reduce morbidity or mortality in mild PHPT. Thus, no evidence of adverse effects of observation was seen for at least a decade with respect to mortality, fractures, cancer, cardiovascular and cerebrovascular events, or renal morbidities. PRIMARY FUNDING SOURCE Swedish government, Norwegian Research Council, and South-Eastern Norway Regional Health Authority.
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Affiliation(s)
- Mikkel Pretorius
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway (M.P., A.H., J.B.)
| | - Karolina Lundstam
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, and Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (K.L., M.H.)
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway (M.P., A.H., J.B.)
| | - Morten W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway (M.W.F.)
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway (K.G.)
| | - Charlotte Mollerup
- Clinic of Breast and Endocrine Surgery, Center HOC, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (C.M.)
| | - Stine L Fougner
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (S.L.F.)
| | - Ylva Pernow
- Department of Molecular Medicine and Surgery, Department of Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (Y.P.)
| | - Turid Aas
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway (T.A.)
| | - Ola Hessman
- Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanland Hospital, Västerås, Sweden (O.H.)
| | - Thord Rosén
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden (T.R.)
| | - Jörgen Nordenström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (J.N.)
| | - Svante Jansson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden (S.J.)
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, and Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (K.L., M.H.)
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway (M.P., A.H., J.B.)
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Skogastierna C, Elfvin A, Hansson S, Magnusson P, Swolin‐Eide D. Impaired renal clearance among Swedish adolescents born preterm. Acta Paediatr 2022; 111:1722-1728. [PMID: 35490381 PMCID: PMC9545013 DOI: 10.1111/apa.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022]
Abstract
AIM To determine whether adolescents born before 28 gestational weeks have an increased risk for renal impairment. METHODS Swedish infants, born before 28 gestational weeks in 2001 and 2002, were identified from a local register. A total of 16 children, 12 females and 4 males, were examined at 16-17 years of age with 51 Cr-EDTA clearance. A comparison group (n = 26) was used. RESULTS Most study participants (n = 13) had normal blood pressure; one individual had hypertension stage 1. All study participants had results within the reference interval for ionised calcium, parathyroid hormone, intact fibroblast growth factor-23 and for urinary albumin-to-creatinine ratio. Four out of 16 participants (25%) had a 51 Cr-EDTA clearance less than 90 ml/min/1.73 m2 , indicating a reduced kidney function. Measured 51 Cr-EDTA clearance values were significantly lower in the study group than in the comparison group (p = 0.0012). Five study participants (31%) were referred for further investigations. CONCLUSION Swedish children born before 28 gestational weeks have an increased risk of renal impairment later in life, suggesting that the kidney function in these individuals should be assessed, at least once, during adolescence.
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Affiliation(s)
- Carin Skogastierna
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Anders Elfvin
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Sverker Hansson
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Per Magnusson
- Department of Clinical Chemistry Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Diana Swolin‐Eide
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
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Liu Q, Qi H, Yao L. A long non-coding RNA H19/microRNA-138/TLR3 network is involved in high phosphorus-mediated vascular calcification and chronic kidney disease. Cell Cycle 2022; 21:1667-1683. [PMID: 35435133 PMCID: PMC9302514 DOI: 10.1080/15384101.2022.2064957] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Vascular calcification, characterized by the accumulation of calcium-phosphate crystals in blood vessels, is a major cause of cardiovascular complications and chronic kidney disease (CKD)-related death. This work focuses on the molecules involved in high-phosphorus-mediated vascular calcification in CKD. A rat model of CKD was established by 5/6 nephrectomy, and the rats were given normal phosphorus diet (NPD) or high phosphorus diet (HPD). HPD decreased kidney function, increased the concentration of calcium ion and damaged vascular structure in the thoracic aorta of diseased rats. A high phosphorus condition enhanced calcium deposition in vascular smooth muscle cells (VSMCs). High phosphorus also increased the expression of RUNX2 whereas reduced the expression of α-SM actin in the aortic tissues and VSMCs. Long non-coding RNA (lncRNA) H19 was upregulated in the aortic tissues after HPD treatment. H19 bound to microRNA (miR)-138 to block its inhibitory effect on TLR3 mRNA and activated the NF-κB signaling pathway. Downregulation of H19 or TLR3 alleviated, whereas downregulation of miR-138 aggravated the calcification and vascular damage in model rats and VSMCs. In conclusion, this study demonstrates that the H19/miR-138/TLR3 axis is involved in high phosphorus-mediated vascular calcification in rats with CKD.
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Affiliation(s)
- Qiang Liu
- Department of Nephrology, Fuyang Hospital of Anhui Medical University, Fuyang Anhui, P.R. China
| | - Huimeng Qi
- Department of General Practice, Fuyang Hospital of Anhui Medical University, Fuyang Anhui, P.R. China
| | - Li Yao
- Department of Nephrology, The First Hospital of China Medical University, Shenyang Liaoning, P.R. China
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Di Girolamo N. Relationship, difference, and diagnostic discordance between blood ionized and total calcium concentrations in client-owned chelonians. J Am Vet Med Assoc 2022; 260:S101-S110. [PMID: 35290208 DOI: 10.2460/javma.21.05.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine (1) the relationship, (2) the difference, and (3) the diagnostic discordance between blood total calcium concentration (tCa) and ionized calcium concentration (iCa) in a population of client-owned chelonian patients. ANIMALS 161 consecutively admitted client-owned chelonians. PROCEDURES Results for tCa, iCa, and other variables were extracted from records. Bound calcium concentration (tCa - iCa) was calculated. General linear models were developed to evaluate factors affecting tCa, iCa and bound calcium concentrations. Diagnostic discordance between tCa and iCa was assessed. RESULTS iCa decreased with increasing albumin concentration, it was not influenced by sex, and it was lower in chelonians with disorders of the reproductive tract than in those with disorders of the endocrine/hemopoietic and urinary systems. Total calcium and bound calcium concentrations increased with increasing albumin concentration; they were higher in females and in chelonians with disorders of the reproductive tract. Of the 161 chelonians, 93 (57.7%; 95% CI, 49.7% to 65.5%) would have had a different diagnosis of calcium status based on tCa and iCa results (ie, diagnostic discordance). A 2.2 mmol/L cutoff value for bound calcium could differentiate chelonians with and without disorders of the reproductive tract with a sensitivity (95% CI) of 81.8% (64.5% to 93.0%) and specificity of 76.4% (68.0% to 83.5%). CLINICAL RELEVANCE tCa and iCa were related and were associated with albumin concentrations in chelonians. Evaluation of tCa or iCa alone is likely to result in underdiagnosis of alterations of the calcium status. Calculation of bound calcium concentration could help identify chelonians with reproductive disorders.
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Yuan S, Yu L, Gou W, Wang L, Sun J, Li D, Lu Y, Cai X, Yu H, Yuan C, Zheng JS, Larsson SC, Theodoratou E, Li X. Health effects of high serum calcium levels: Updated phenome-wide Mendelian randomisation investigation and review of Mendelian randomisation studies. EBioMedicine 2022; 76:103865. [PMID: 35134646 PMCID: PMC8844774 DOI: 10.1016/j.ebiom.2022.103865] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/08/2023] Open
Abstract
Background Calcium plays a role in a wide range of biological functions. Here we conducted a phenome-wide Mendelian randomisation (MR-PheWAS) analysis and a systematic review for MR studies to comprehensively investigate the health effects of serum calcium. Methods One-hundred and thirty genetic variants strongly associated with serum calcium levels were used as instrumental variables. A phenome-wide association analysis (PheWAS) was conducted to examine the associations of genetically predicted serum calcium with 1473 distinct phenotypes in the UK Biobank including 339,197 individuals. Observed associations in PheWAS were further tested for replication in two-sample MR replication analysis. A systematic review for MR studies on serum calcium was performed to synthesize the published evidence and compare with the current MR-PheWAS findings. Findings Higher genetically predicted calcium levels were associated with decreased risk of 5 diseases in dermatologic and musculoskeletal systems and increased risk of 17 diseases in circulatory, digestive, endocrine, genitourinary and immune systems. Eight associations were replicated in two-sample MR analysis. These included decreased risk of osteoarthritis and increased risk of coronary artery disease, myocardial infarction, coronary atherosclerosis, hyperparathyroidism, disorder of parathyroid gland, gout, and calculus of kidney and ureter with increased serum calcium. Systematic review of 25 MR studies provided supporting evidence on five out of the eight disease outcomes, while the increased risk of gout, hyperparathyroidism and disorder of parathyroid gland were novel findings. Interpretation This study found wide-ranged health effects of high serum calcium, which suggests that the benefits and adversities of strategies promoting calcium intake should be assessed. Funding ET is supported by a CRUK Career Development Fellowship (C31250/A22804). XL is supported by the Natural Science Fund for Distinguished Young Scholars of Zhejiang Province. SCL acknowledges research funding from the Swedish Heart Lung Foundation (Hjärt-Lungfonden, 20210351), the Swedish Research Council (Vetenskapsrådet, 2019-00977), and the Swedish Cancer Society (Cancerfonden).
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Affiliation(s)
- Shuai Yuan
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
| | - Lili Yu
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wanglong Gou
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
| | - Lijuan Wang
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Sun
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Doudou Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Lu
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaxia Cai
- Department of Nutrition and Food Hygiene, Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Huanling Yu
- Department of Nutrition and Food Hygiene, Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Changzheng Yuan
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Ju-Sheng Zheng
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK; Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Xue Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Jung DH, Park B, Lee YJ. Longitudinal Effects of Serum Calcium and Phosphate Levels and Their Ratio on Incident Ischemic Heart Disease among Korean Adults. Biomolecules 2022; 12:biom12010103. [PMID: 35053252 PMCID: PMC8773691 DOI: 10.3390/biom12010103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/05/2023] Open
Abstract
Serum calcium and phosphate levels are controlled by a regulatory system, but their individual concentration tendencies and interactions may affect long-term vascular health. This study aimed to assess the effects of serum calcium and phosphate levels on incident ischemic heart disease (IHD) in a large-scale community-dwelling Korean cohort. We evaluated 15,259 non-diabetic individuals (median age, 45 years; range, 30–85) without previous IHD or ischemic stroke using the Korean National Health Insurance data. The study population was classified based on the calcium, phosphate, and calcium/phosphate ratios. Using Cox proportional hazards regression models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD over 50 months after baseline enrolment. The age- and sex-adjusted incidence of IHD gradually increased with serum calcium and phosphate quartiles and decreased with calcium/phosphate ratio quartiles, with an overall crude rate of 2.1% (315/15,259). After setting the lowest calcium, phosphate, and calcium/phosphate ratio quartiles as a reference group, the HRs (95% CIs) of the highest calcium, phosphate, and calcium/phosphate ratio quartiles for IHD were 1.77 (1.15–2.72), 1.73 (1.18–2.55), and 0.58 (0.39–0.87), respectively, after adjusting for potential confounding variables. Serum calcium and phosphate levels were positively associated with IHD incidence, while the serum calcium/phosphate ratio exhibited an inverse relationship. Serum calcium and phosphate homeostasis may merit serious consideration to understand the pathogenesis of coronary atherosclerosis as a risk modifier for IHD.
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Affiliation(s)
- Dong Hyuk Jung
- Department of Health Check-Up, Yongin Severance Hospital, Yongin-si 16995, Korea; (D.H.J.); (B.P.)
| | - Byoungjin Park
- Department of Health Check-Up, Yongin Severance Hospital, Yongin-si 16995, Korea; (D.H.J.); (B.P.)
| | - Yong Jae Lee
- Department of Family Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Seoul 06273, Korea
- Correspondence:
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Qin X, Cen J, Hu H, Chen X, Wei Z, Wan Q, Cao R. Non-linear relationship between albumin-corrected calcium and 30-day in-hospital mortality in ICU patients: A multicenter retrospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1059201. [PMID: 36619536 PMCID: PMC9810799 DOI: 10.3389/fendo.2022.1059201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Albumin-corrected calcium is usually calculated to reflect the real serum calcium level of the whole body by physicians. However, studies on the association between albumin-corrected calcium and 30-day in-hospital mortality in Intensive Care Unit (ICU) patients are rare. The purpose of our study was to explore the association between baseline albumin-corrected calcium and 30-day in-hospital mortality in the American ICU population. METHODS A multicenter retrospective cohort study of 102,245 ICU patients in the eICU-CRD v2.0 from the USA during 2014-2015 was performed. The average age was 63.7 ± 16.9 years, of which 55,313 (53.7%) were men and 47,758 (46.3%) were women. The association between albumin-corrected calcium and 30-day in-hospital mortality was analyzed by Cox proportional-hazards regression, smooth curve fitting, piecewise linear regression, subgroup analyses, and a series of sensitivity analyses. RESULTS We found that among ICU patients with calcium abnormalities, more than 95% were mild hypocalcemia or mild hypercalcemia. The risk of 30-day in-hospital mortality will increase by 10% in the ≥7.5-< 8.5 mg/dl subgroup (OR=1.1, 95% CI 1.0-1.3) or 20% in the ≥10.3-<12 mg/dl subgroup (OR=1.2, 95% CI 1.1-1.3) when the albumin-corrected calcium level increases by 1 mg/dl. Additionally, the relationship between albumin-corrected calcium and 30-day in-hospital mortality was U shaped; the inflection point was 8.9 mg/dl (log likelihood ratio test P = 0.005). Finally, after a series of sensitivity analyses, we found that the relationship between albumin-corrected calcium and 30-day in-hospital mortality remained significant. CONCLUSION In a large nationally representative cohort of ICU patients, abnormalities in albumin-corrected calcium, particularly slight hypocalcemia or slight hypercalcemia, were associated with an increased 30-day in-hospital mortality risk, and yet the findings in this study need to be further confirmed by prospective studies.
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Affiliation(s)
- Xun Qin
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
| | - Ji Cen
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xinglin Chen
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Epidemiology and Biostatistics, Empower U, X&Y Solutions Inc., Boston, MA, United States
| | - Zhe Wei
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
- *Correspondence: Rong Cao, ; Qijun Wan, ; Zhe Wei,
| | - Qijun Wan
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Rong Cao, ; Qijun Wan, ; Zhe Wei,
| | - Rong Cao
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Rong Cao, ; Qijun Wan, ; Zhe Wei,
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Meng X, Han T, Jiang W, Dong F, Sun H, Wei W, Yan Y. Temporal Relationship Between Changes in Serum Calcium and Hypercholesteremia and Its Impact on Future Brachial-Ankle Pulse Wave Velocity Levels. Front Nutr 2021; 8:754358. [PMID: 34869527 PMCID: PMC8635801 DOI: 10.3389/fnut.2021.754358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The high levels of serum calcium and cholesterol are the important risk factors of cardiovascular disease (CVD), which frequently influence each other during the development of CVD. However, few studies have examined their temporal relationship to confirm the precursor, and it is still largely unknown whether and how their temporal relationship would influence the development of CVD. This study aimed to establish the temporal relationship between the changes in serum calcium and cholesterol using the longitudinal cohort data, and examine whether this temporal relationship influenced the arterial elasticity indicated by brachial-ankle pulse wave velocity (baPWV). Methods: This is a cohort study with a sample of 3,292 Chinese participants (aged 20-74 years) with 5.7 years follow-up. Serum calcium and cholesterol were measured at baseline and follow-up survey. The cross-lagged path analysis was used to examine their temporal relationship, and mediation analysis was performed to evaluate the potential mediating effect. Results: The cross-lagged path coefficients (β2 values) from baseline serum calcium to follow-up cholesterol was significantly greater than the path coefficients (β1 values) from baseline cholesterol to follow-up serum calcium (β2 = 0.110 vs. β1 = 0.047; P = 0.010) after adjusting for the multiple covariates. The path coefficients from baseline serum calcium to follow-up cholesterol in the participants with high baPWV was significantly greater than the participants with low baPWV (β2 = 0.155 for high baPWV and β2 = 0.077 for low baPWV, P = 0.028 for the difference between the β2 values). Moreover, cholesterol partially mediated the association between the higher serum calcium and greater subsequent baPWV values, the percentage of the total effect mediated by cholesterol was estimated at 21.7%. Conclusion: Our findings indicate that increased serum calcium precedes increased in serum cholesterol, and this temporal relationship may contribute to the development of higher baPWV levels.
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Affiliation(s)
- Xing Meng
- Division of Clinical Nutrition, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianshu Han
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Wenbo Jiang
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Fengli Dong
- Division of Clinical Nutrition, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongxue Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Wei
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Yageng Yan
- Division of Clinical Nutrition, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Gorący I, Rębacz-Maron E, Korbecki J, Gorący J. Concentrations of Mg, Ca, Fe, Cu, Zn, P and anthropometric and biochemical parameters in adults with chronic heart failure. PeerJ 2021; 9:e12207. [PMID: 34760349 PMCID: PMC8567860 DOI: 10.7717/peerj.12207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background The study investigated the relationship between the concentrations of Mg, Ca, Fe, Cu, Zn, P and anthropometric and biochemical parameters in the blood serum of patients with heart failure (HF) and the potential influence on the development and progression of HF. Material & methods The study included 214 patients (155 men and 59 women), aged 40–87 years, presenting symptoms or signs typical of HF (according to the NYHA functional classification). Serum concentrations were determined for Mg, Ca, Fe, Cu, Zn, P, C-reactive protein (CRP), creatinine, urea, triglyceride levels (TG), total cholesterol (CH), high density protein (HDL), low density protein (LDL). The levels of macro-and microminerals were analysed using inductively coupled serum optical emission spectrometry (ICP-OES). Results Our study confirmed the role of known risk factors in the development of heart failure, including: overweight, diabetes, hypertension, high triglycerides (TG), high total cholesterol (CH), high levels of low density protein (LDL) and reduced levels of high density protein (HDL), high CRP, high creatinine. Moreover, deficient serum concentrations of Mg (47% of the studied men and 54% of the women) and Cu (in 44% of men and more than 30% of women) were observed, as well as subnormal serum Fe (2% of women) and Zn (1% of men). Elevated serum Ca was found in 50% of men and 49% of women. In 44% of the studied men and 52% of the studied women, P levels in serum were also above-average. The study revealed a significant positive correlation between serum levels of Ca and Mg, and also Ca and Cu in women. In men, serum Cu was positively correlated with Mg and Ca concentrations. In patients from group 1 (NYHA I–II), Mg content was positively correlated with Ca and Cu. In this patient group, Ca was also positively associated with Cu content in serum. In group 2 (NYHA III-IV), serum Mg concentration was significantly positively correlated with that of Cu and Ca. Conclusions Changes in the serum concentrations of macro-and microminerals may significantly affect the severity of HF in Polish patients.
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Affiliation(s)
- Iwona Gorący
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Rębacz-Maron
- Institute of Biology, Department of Ecology and Anthropology, University of Szczecin, Szczecin, Poland
| | - Jan Korbecki
- Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wrocław, Poland
| | - Jarosław Gorący
- Clinic of Cardiology, Pomeranian Medical University, Szczecin, Poland
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Wermers RA, Griebeler ML, Thapa P, Hathcock MA, Kearns AE. Survival in primary hyperparathyroidism over five decades (1965-2010) a population-based retrospective study. Bone 2021; 152:116099. [PMID: 34245931 PMCID: PMC10495014 DOI: 10.1016/j.bone.2021.116099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/10/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Survival in patients with primary hyperparathyroidism (PHPT) remains uncertain. OBJECTIVE To update survival in patients with PHPT in a United States community population. DESIGN Retrospective cohort study. SETTING Community population in Rochester, Minnesota. PARTICIPANTS Residents who met criteria for PHPT from 1965 to 2010. INTERVENTIONS Survival was estimated using the Kaplan Meier product-limit method. The Cox proportional hazards model was used to determine associations, as relative hazards (RR) with 95% confidence intervals (CI), of various risk factors with time to death. MAIN OUTCOME MEASURE The overall age and gender-adjusted survival compared to white Minnesota residents. RESULTS We identified 1139 PHPT individuals, 76% female, with a median age of 58 years. Most were observed without parathyroidectomy (69%). The relative risk of death among the entire cohort was 0.996 (95% CI: 0.91-1.09, P = 0.935) which was not different compared to Minnesota residents. Those with maximum serum calcium level ≥ 10.8 mg/dL (0.7 mg/dL above the reference range) had an increase in mortality (RR 1.32, 95% CI: 1.10-1.58, P = 0.002). Survival among all PHPT individuals after parathyroidectomy was no different from expected (RR = 1.06, 95% CI 0.89-1.28; P = 0.508). Mortality was significantly decreased after parathyroidectomy in those with serum calcium levels ≥10.8 mg/dL (HR 0.47, 95% CI: 0.36-0.61, P < 0.001). CONCLUSIONS Mortality in the entire cohort was not different from expected. PHPT patients with a maximum serum calcium level ≥ 10.8 mg/dL had increased mortality. Survival was improved after parathyroidectomy in those with this degree of hypercalcemia.
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Affiliation(s)
- Robert A Wermers
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Prabin Thapa
- Divisions of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew A Hathcock
- Divisions of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ann E Kearns
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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35
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Chen Y, Forgetta V, Richards JB, Zhou S. Health Effects of Calcium: Evidence From Mendelian Randomization Studies. JBMR Plus 2021; 5:e10542. [PMID: 34761146 PMCID: PMC8567492 DOI: 10.1002/jbm4.10542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022] Open
Abstract
Calcium is widely used in conjunction with vitamin D to prevent osteoporosis. The use of calcium supplementation is also promoted for its potential benefits in lowering the risk for metabolic syndromes and cancers. However, the causal link between calcium and various health outcomes remains unclear. This review focuses on the evidence from 24 Mendelian randomization (MR) studies that were designed to minimize bias from confounding and reverse causation. These MR studies evaluated the effect of lifelong genetically higher serum calcium levels on various health outcomes. Overall, available MR studies found no conclusive effects of serum calcium levels on bone mineral density and fracture, ischemic stroke and heart failure, cancers, type 2 diabetes, Parkinson disease, or offspring birth weight. However, a higher serum calcium concentration was reported to have estimated causal effects on increased risks for coronary artery disease (especially myocardial infarction), migraine, renal colic, allergy/adverse effect of penicillin, and reduced risks for osteoarthrosis and osteoarthritis. In conclusion, supplementation of calcium in individuals from the general population is not predicted to influence the risk of most investigated diseases to date. Moreover, long-term high serum calcium concentrations may result in adverse health outcomes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Yiheng Chen
- Department of Human GeneticsMcGill UniversityMontréalQCCanada
- Lady Davis Institute, Jewish General HospitalMcGill UniversityMontréalQCCanada
| | - Vincenzo Forgetta
- Lady Davis Institute, Jewish General HospitalMcGill UniversityMontréalQCCanada
| | - J. Brent Richards
- Department of Human GeneticsMcGill UniversityMontréalQCCanada
- Lady Davis Institute, Jewish General HospitalMcGill UniversityMontréalQCCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalQCCanada
- Department of Twin ResearchKing's College LondonLondonUK
| | - Sirui Zhou
- Lady Davis Institute, Jewish General HospitalMcGill UniversityMontréalQCCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalQCCanada
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Abstract
Magnetic resonance imaging (MRI) is one of the most powerful imaging tools today, capable of displaying superior soft-tissue contrast. This review discusses developments in the field of 19 F MRI multimodal probes in combination with optical fluorescence imaging (OFI), 1 H MRI, chemical exchange saturation transfer (CEST) MRI, ultrasonography (USG), X-ray computed tomography (CT), single photon emission tomography (SPECT), positron emission tomography (PET), and photoacoustic imaging (PAI). In each case, multimodal 19 F MRI probes compensate for the deficiency of individual techniques and offer improved sensitivity or accuracy of detection over unimodal counterparts. Strategies for designing 19 F MRI multimodal probes are described with respect to their structure, physicochemical properties, biocompatibility, and the quality of images.
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Affiliation(s)
- Dawid Janasik
- Department of Chemical Organic Technology and Petrochemistry, Silesian University of Technology, Krzywoustego, 4, 44-100, Gliwice, Poland
| | - Tomasz Krawczyk
- Department of Chemical Organic Technology and Petrochemistry, Silesian University of Technology, Krzywoustego, 4, 44-100, Gliwice, Poland
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37
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Serum calcium and 25-hydroxyvitamin D in relation to longevity, cardiovascular disease and cancer: a Mendelian randomization study. NPJ Genom Med 2021; 6:86. [PMID: 34650087 PMCID: PMC8516873 DOI: 10.1038/s41525-021-00250-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/23/2021] [Indexed: 12/24/2022] Open
Abstract
Associations of serum calcium (S-Ca) and 25-hydroxyvitamin D (S-25(OH)D) concentrations with longevity, cardiovascular disease, and cancer are not clear. We conducted a Mendelian randomization study to examine the associations of S-Ca and S-25(OH)D with longevity and risk of cardiovascular disease and cancer. The primary genetic instruments for S-Ca and S-25(OH)D were obtained from genome-wide association meta-analyses that included 61,054 individuals for S-Ca and up to 79,366 individuals for S-25(OH)D. Genetic variants associated with S-Ca and S-25(OH)D in the UK Biobank were used as confirmatory instruments. We obtained summary-level data for associations of these instruments with individual survival later than the 90th versus at most the 60th percentile of expected age at death from a genome-wide association meta-analysis including 11,262 cases and 25,483 controls, and with parental longevity (both parents in top 10% percentile) from the UK Biobank including 7,182 cases and 79,767 controls. Data for cardiovascular disease (111,108 cases and 107,684 controls) and cancer (38,036 cases and 180,756 controls) were obtained from the FinnGen consortium. A one standard deviation increase in genetically-predicted S-Ca concentration was associated with lower odds of longevity (odds ratio, 0.72; 95% CI, 0.55-0.95) and increased risk of cardiovascular disease (odds ratio, 1.11; 95% CI, 1.03-1.20). The associations were consistent in confirmatory analyses. There was no evidence supporting an association between genetically-predicted S-Ca and cancer, and no associations of genetically-predicted S-25(OH)D with the studied outcomes. Lifelong higher levels of S-Ca but not S-25(OH)D may shorten life expectancy and increase the risk of cardiovascular disease.
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Chen S, Yang F, Xu T, Wang Y, Zhang K, Fu G, Zhang W. The impact of serum 25-hydroxyvitamin D, calcium, and parathyroid hormone levels on the risk of coronary artery disease in patients with diabetes: a Mendelian randomization study. Nutr J 2021; 20:82. [PMID: 34602077 PMCID: PMC8489084 DOI: 10.1186/s12937-021-00735-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the causal association between serum 25-hydroxyvitamin D (25OHD), calcium (Ca), and parathyroid hormone (PTH) levels and the risk of coronary artery disease (CAD) in patients with diabetes using a Mendelian randomization approach. METHODS Genetic signatures associated with serum 25OHD, Ca, and PTH levels were extracted from recently published genome-wide association study (GWAS), including 79,366, 39,400, 29,155 individuals, respectively. Genetic association estimates for CAD in patients with diabetes were obtained from a GWAS of 15,666 individuals with diabetes (3,968 CAD cases, 11,696 controls). The inverse-variance-weighted method was employed for the primary analysis, and other robust methods were applied for sensitivity analyses. RESULTS Six, seven and five single nucleotide polymorphisms were identified as instrumental variables for serum 25OHD, Ca and PTH levels, respectively. There was no significant association between genetically predicted serum 25OHD levels and the risk of CAD in patients with diabetes (odds ratio (OR) = 1.04, 95% confidence interval (CI): 0.58 - 1.87, P = 0.888). Similarly, genetically predicted serum Ca (OR = 1.83, 95% CI: 0.62 - 5.35, P = 0.273) and PTH levels (OR = 1.27, 95% CI: 0.67 - 2.44, P = 0.464) were not significantly associated with the risk of CAD in patients with diabetes. These findings were robust in sensitivity analyses. CONCLUSIONS/INTERPRETATION Serum 25OHD, Ca and PTH levels may not be causally associated with the risk of CAD in patients with diabetes.
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Affiliation(s)
- Songzan Chen
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Fangkun Yang
- Department of Cardiology, Ningbo First Hospital, School of Medicine, Zhejiang University, Ningbo, 315010, China
| | - Tian Xu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Yao Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Kaijie Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Guosheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
| | - Wenbin Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
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Narayanam H, Chinni SV, Samuggam S. The Impact of Micronutrients-Calcium, Vitamin D, Selenium, Zinc in Cardiovascular Health: A Mini Review. Front Physiol 2021; 12:742425. [PMID: 34566703 PMCID: PMC8458831 DOI: 10.3389/fphys.2021.742425] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/23/2021] [Indexed: 01/14/2023] Open
Abstract
The role of micronutrients in health and disease has increased the curiosity and interest among researchers. The prime focus of this review is the significance of trace elements- calcium, vitamin D, selenium and zinc with cardiovascular health. WHO identified cardiovascular diseases (CVD) as the leading cause of deaths globally. Identifying the risk factors that could be modified and creating new treatment strategies remains to be the main concern for CVD prevention. The data that showed the relationship between trace elements and various ways in which they may contribute to cardiovascular health and disease from clinical trials and observational studies were collected from databases such as PubMed and Embase. Based on these collected data, it shows that either high or low circulating serum levels can be associated with the development of cardiovascular diseases. Micronutrients through diet contribute to improved cardiac health. However, due to our current lifestyle, there is a huge dependency on dietary supplements. Based on the observational studies, it is evident that supplements cause sudden increase in the circulating levels of the nutrients and result in cardiovascular damage. Thus, it is advisable to restrict the use of supplements, owing to the potent risks it may cause. In order to understand the exact mechanism between micronutrients and cardiac health, more clinical studies are required.
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Affiliation(s)
- Harini Narayanam
- Department of Physiology, Manipal University College Malaysia (MUCM), Melaka, Malaysia
| | - Suresh V Chinni
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Bedong, Malaysia
| | - Sumitha Samuggam
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Bedong, Malaysia
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The Association between Branched-Chain Amino Acids (BCAAs) and Cardiometabolic Risk Factors in Middle-Aged Caucasian Women Stratified According to Glycemic Status. Nutrients 2021; 13:nu13103307. [PMID: 34684308 PMCID: PMC8538048 DOI: 10.3390/nu13103307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023] Open
Abstract
We examined the glycemic status-stratified relationships between total serum branched-chain amino acid (BCAA) concentrations and cardiometabolic risk factors in middle-aged Caucasian women. The study included 349 women divided into 2 subgroups: a normoglycemic group (NG, n = 184) and a dysglycemic group (DG, n = 165). Blood samples, anthropometric parameters, and blood pressure were measured. HOMA-IR, albumin-corrected calcium (CCa), and fatty liver index (FLI) were calculated. BCAA concentrations were higher in the women with dysglycemia. BCAAs moderately correlated with BMI and FLI in the NG group and with BMI, FLI, total calcium (TCa), CCa, HbA1c, TG/HDL-C, and HDL-C in the DG group. After adjusting for age and BMI, correlations for TCa, CCa, HbA1c, HDL-C, and TG/HDL-C remained significant. The coexistence of increased BCAAs with dysglycemic status was associated with markedly higher concentrations of TCa, CCa, HbA1c, and TG, which were not observed in the DG women with low level of BCAAs. Multiple regression showed that TCa or CCa, age and BCAAs were significantly associated with HbA1c independently of BMI only in the DG group. We conclude that dysglycemia in particular predisposes women to a significant relationship between total BCAAs and circulating calcium and HbA1c, and that these relationships are independent of BMI and may reflect the pathophysiological calcium-dependent mechanisms connecting BCAAs with metabolic disturbances.
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41
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Ohukainen P, Virtanen JK, Ala-Korpela M. Vexed causal inferences in nutritional epidemiology-call for genetic help. Int J Epidemiol 2021; 51:6-15. [PMID: 34387668 PMCID: PMC8856007 DOI: 10.1093/ije/dyab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Pauli Ohukainen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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42
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Tang PK, Geddes RF, Jepson RE, Elliott J. A feline-focused review of chronic kidney disease-mineral and bone disorders - Part 1: Physiology of calcium handling. Vet J 2021; 275:105719. [PMID: 34311095 DOI: 10.1016/j.tvjl.2021.105719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 06/03/2021] [Accepted: 07/21/2021] [Indexed: 01/01/2023]
Abstract
Mineral derangements are a common consequence of chronic kidney disease (CKD). Despite the well-established role of phosphorus in the pathophysiology of CKD, the implications of calcium disturbances associated with CKD remain equivocal. Calcium plays an essential role in numerous physiological functions in the body and is a fundamental structural component of bone. An understanding of calcium metabolism is required to understand the potential adverse clinical implications and outcomes secondary to the (mal)adaptation of calcium-regulating hormones in CKD. The first part of this two-part review covers the physiology of calcium homeostasis (kidneys, intestines and bones) and details the intimate relationships between calcium-regulating hormones (parathyroid hormone, calcitriol, fibroblast growth factor 23, α-Klotho and calcitonin) and the role of the calcium-sensing receptor.
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Affiliation(s)
- Pak-Kan Tang
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK.
| | - Rebecca F Geddes
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
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Kobylecki CJ, Nordestgaard BG, Afzal S. Plasma Ionized Calcium and Risk of Cardiovascular Disease: 106 774 Individuals from the Copenhagen General Population Study. Clin Chem 2021; 67:265-275. [PMID: 33418574 DOI: 10.1093/clinchem/hvaa245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Circulating total calcium or albumin-adjusted calcium is a risk factor for cardiovascular disease. As the biologically active ionized calcium is a physiologically more relevant measure and its association with cardiovascular disease is poorly understood, we tested the hypothesis that high plasma ionized calcium is associated with higher risk of myocardial infarction and ischemic stroke in individuals in the general population. METHODS We included 106 774 individuals from the Copenhagen General Population Study, and defined hypocalcemia and hypercalcemia by the lowest and highest 2.5 percentiles, respectively, using the central 95% reference interval. Information on myocardial infarction and ischemic stroke was from registries and risks calculated using Cox regression and Fine and Gray competing-risks regression. RESULTS During a median follow-up of 9.2 years, 4932 individuals received a diagnosis of either myocardial infarction or ischemic stroke. Hypercalcemia was associated with subdistribution hazard ratios of 1.67 (95%CI: 1.05-2.67) for myocardial infarction, 1.28 (0.81-2.02) for ischemic stroke, and of 1.54 (1.10-2.15) for the combined endpoint compared to individuals with plasma ionized calcium within the reference interval; hypocalcemia was not associated with cardiovascular disease. In models using plasma ionized calcium as a continuous variable, the associations were nonlinear; above the median, each 0.1 mmol/L higher plasma ionized calcium was associated with a hazard ratio of 1.31(1.02-1.68) for myocardial infarction, 1.21 (0.95-1.54) for ischemic stroke, and of 1.28 (1.08-1.53) for the combined endpoint. CONCLUSIONS High plasma ionized calcium is associated with higher risk of myocardial infarction and ischemic stroke compared to plasma ionized calcium within the reference interval.
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Affiliation(s)
- Camilla J Kobylecki
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Young WJ, Warren HR, Mook-Kanamori DO, Ramírez J, van Duijvenboden S, Orini M, Tinker A, van Heemst D, Lambiase PD, Jukema JW, Munroe PB, Noordam R. Genetically Determined Serum Calcium Levels and Markers of Ventricular Repolarization: A Mendelian Randomization Study in the UK Biobank. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2021; 14:e003231. [PMID: 33887147 PMCID: PMC8208093 DOI: 10.1161/circgen.120.003231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND ECG markers of ventricular depolarization and repolarization are associated with an increased risk of arrhythmia and sudden cardiac death. Our prior work indicated lower serum calcium concentrations are associated with longer QT and JT intervals in the general population. Here, we investigate whether serum calcium is a causal risk factor for changes in ECG measures using Mendelian randomization (MR). METHODS Independent lead variants from a newly performed genome-wide association study for serum calcium in >300 000 European-ancestry participants from UK Biobank were used as instrumental variables. Two-sample MR analyses were performed to approximate the causal effect of serum calcium on QT, JT, and QRS intervals using an inverse-weighted method in 76 226 participants not contributing to the serum calcium genome-wide association study. Sensitivity analyses including MR-Egger, weighted-median estimator, and MR pleiotropy residual sum and outlier were performed to test for the presence of horizontal pleiotropy. RESULTS Two hundred five independent lead calcium-associated variants were used as instrumental variables for MR. A decrease of 0.1 mmol/L serum calcium was associated with longer QT (3.01 ms [95% CI, 2.03 to 3.99]) and JT (2.89 ms [1.91 to 3.87]) intervals. A weak association was observed for QRS duration (secondary analyses only). Results were concordant in all sensitivity analyses. CONCLUSIONS These analyses support a causal effect of serum calcium levels on ventricular repolarization, in a middle-aged population of European-ancestry where serum calcium concentrations are likely stable and chronic. Modulation of calcium concentration may, therefore, directly influence cardiovascular disease risk.
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Affiliation(s)
- William J. Young
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
| | - Helen R. Warren
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Dennis O. Mook-Kanamori
- Department of Clinical Epidemiology (D.O.M.-K.), Leiden University Medical Center, the Netherlands
- Department of Public Health and Primary Care (D.O.M.-K.), Leiden University Medical Center, the Netherlands
| | - Julia Ramírez
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Stefan van Duijvenboden
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Michele Orini
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Andrew Tinker
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Diana van Heemst
- Department of Internal Medicine (D.v.H., R.N.), Leiden University Medical Center, the Netherlands
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - J. Wouter Jukema
- Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (J.W.J.)
| | - Patricia B. Munroe
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Raymond Noordam
- Department of Internal Medicine (D.v.H., R.N.), Leiden University Medical Center, the Netherlands
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Rudko M, Urbaniak T, Musiał W. Recent Developments in Ion-Sensitive Systems for Pharmaceutical Applications. Polymers (Basel) 2021; 13:1641. [PMID: 34070206 PMCID: PMC8158499 DOI: 10.3390/polym13101641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/18/2022] Open
Abstract
Stimuli-responsive carriers of pharmaceutical agents have been extensively researched in recent decades due to the possibility of distinctively precise targeted drug delivery. One of the potentially beneficial strategies is based on the response of the medical device to changes in the ionic environment. Fluctuations in ionic strength and ionic composition associated with pathological processes may provide triggers sufficient to induce an advantageous carrier response. This review is focused on recent developments and novel strategies in the design of ion-responsive drug delivery systems. A variety of structures i.e., polymeric matrices, lipid carriers, nucleoside constructs, and metal-organic frameworks, were included in the scope of the summary. Recently proposed strategies aim to induce different pharmaceutically beneficial effects: localized drug release in the desired manner, mucoadhesive properties, increased residence time, or diagnostic signal emission. The current state of development of ion-sensitive drug delivery systems enabled the marketing of some responsive topical formulations. Concurrently, ongoing research is focused on more selective and complex systems for different administration routes. The potential benefits in therapeutic efficacy and safety associated with the employment of multi-responsive systems will prospectively result in further research and applicable solutions.
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Affiliation(s)
| | | | - Witold Musiał
- Department of Physical Chemistry and Biophysics, Pharmaceutical Faculty, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland; (M.R.); (T.U.)
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Interaction of serum calcium and folic acid treatment on first stroke in hypertensive males. Clin Nutr 2021; 40:2381-2388. [DOI: 10.1016/j.clnu.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
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Zhang JF, Meng X, Jing J, Pan Y, Wang YL, Zhao XQ, Lin JX, Han XS, Song BB, Jia ZC, Wu SD, Chen XF, Xue WJ, Wu YC, Wang YJ. Serum calcium and long-term outcome after ischemic stroke: Results from the China National stroke registry III. Atherosclerosis 2021; 325:24-29. [PMID: 33887530 DOI: 10.1016/j.atherosclerosis.2021.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Serum calcium abnormality is associated with adverse cardiovascular outcomes, but the effects of serum calcium level on stroke outcomes remain unknown. We aimed to assess the relationship between serum calcium level and 1-year outcomes in patients with acute ischemic stroke and transient ischemic attack. METHODS We included 9375 stroke patients from the China National Stroke Registry III for analysis. Participants were divided into 4 groups according to albumin corrected-calcium quartiles. Composite end point comprised recurrent stroke, myocardial infarction, other ischemic vascular events, and all-cause mortality. Multivariable Cox or logistic regression was used to evaluate the independent association of albumin corrected-calcium with all-cause mortality, recurrent stroke, composite end point, and poor functional outcome (modified Rankin Scale score ≥3). RESULTS Compared with the lowest calcium quartile (<2.16 mmol/L), the adjusted hazard ratio (95% CI) of the top quartile (≥2.31 mmol/L) was 1.56 (1.11-2.18) for all-cause mortality, 1.06 (0.87-1.28) for recurrent stroke and 1.08 (0.90-1.01) for composite end point, and the adjusted odds ratio for poor functional outcome was 1.18 (0.96-1.44). The addition of serum calcium to conventional risk factors improved risk prediction of all-cause mortality, leading to a small but significant increase in C-statistics and reclassification with non-significant integrated discrimination improvement (C-statistics, p = 0.02; net reclassification index 11.8%, p = 0.038; integrated discrimination improvement 0.08%, p = 0.42). CONCLUSIONS High serum calcium levels at baseline were associated with all-cause mortality at 1-year after ischemic stroke, suggesting that serum calcium may be a potential prognostic biomarker and therapeutic target for ischemic stroke.
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Affiliation(s)
- Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xing-Quan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jin-Xi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | | | | | | | - Song-Di Wu
- Department of Neurology, The First Hospital of Xi'an, Xi'an, China
| | | | - Wen-Jun Xue
- Pingdingshan First People's Hospital, Pingdingshan, China
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients 2021; 13:nu13020368. [PMID: 33530332 PMCID: PMC7910980 DOI: 10.3390/nu13020368] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Recent systematic reviews and meta-analyses of randomized, double-blind, placebo-controlled trials (double-blind, placebo-controlled RCTs) have reported controversial findings regarding the associations between calcium supplements on the risk of cardiovascular disease (CVD). This meta-analysis aimed to investigate the association between them. Methods: We searched PubMed, EMBASE, the Cochrane Library, and the bibliographies of relevant articles for double-blind, placebo-controlled RCTs in November, 2020. Relative risks (RRs) with 95% confidence intervals (CIs) for the risk of cardiovascular disease were calculated using a random effects model. The main outcomes were CVD, coronary heart disease (CHD), and cerebrovascular disease. Results: A total of 13 double-blind, placebo-controlled RCTs (n = 28,935 participants in an intervention group and 14,243 in a control group)) were included in the final analysis. Calcium supplements significantly increased the risk of CVD (RR 1.15, 95% CI 1.06–1.25], I2 = 0.0%, n = 14) and CHD (RR 1.16, 95% CI 1.05–1.28], I2 = 0.0%, n = 9) in double-blind, placebo-controlled RCTs, specifically in healthy postmenopausal women. In the subgroup meta-analysis, dietary calcium intake of 700–1000 mg per day or supplementary calcium intake of 1000 mg per day significantly increased the risk of CVD and CHD. Conclusions: The current meta-analysis found that calcium supplements increased a risk of CVD by about 15% in healthy postmenopausal women.
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Affiliation(s)
- Seung-Kwon Myung
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
- Cancer Epidemiology Branch, Division of Cancer Epidemiology and Prevention, Research Institute, National Cancer Center, Goyang 10408, Korea
- Department of Family Medicine and Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Goyang 10408, Korea
- Correspondence:
| | - Hong-Bae Kim
- Department of Family Medicine, MyongJi Hospital, Hanyang University College of Medicine, Goyang 10475, Korea;
| | - Yong-Jae Lee
- Department of Family Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea;
| | - Yoon-Jung Choi
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Seung-Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Korea;
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Zhu H, Wang H, Jia Y, Cheng L, Cheng X. Increased serum calcium levels are associated with carotid atherosclerotic plaque in normocalcaemic individuals with type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:2042018821995369. [PMID: 33854752 PMCID: PMC8010831 DOI: 10.1177/2042018821995369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) have an elevated risk of atherosclerotic cardiovascular disease. Although previous data have suggested that serum calcium levels could be involved in T2DM and cardiovascular disease, whether this applies in T2DM patients with atherosclerosis remains unclear. This study therefore aimed to investigate the relationship between serum calcium levels within the physiological ranges and carotid atherosclerotic plaque in T2DM patients. METHODS A total of 594 normocalcaemic in-patients with T2DM were recruited, of whom 231 had carotid atherosclerotic plaque. Serum calcium levels were measured and carotid ultrasonography was performed. RESULTS Patients with plaque had significantly higher serum albumin-corrected calcium than those without plaque [9.02 (8.78-9.34) mg/dL versus 8.86 (8.66-9.06) mg/dL, p < 0.001]. As serum albumin-corrected calcium levels increased across tertiles, the percentage of plaque increased (27.6%, 35.5%, and 55.7%; p < 0.001). Logistic regression showed that serum albumin-corrected calcium levels were independently and positively correlated with the presence of plaque, but not parathyroid hormone levels. Compared with patients in the lowest serum calcium tertiles, the odds ratio for plaque in patients in the upper quartile was 2.47 (95% confidence interval 1.51-4.03, p < 0.001) after adjustment for potential confounders. CONCLUSION Serum albumin-corrected calcium levels are elevated in patients with T2DM and carotid atherosclerotic plaques.
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Affiliation(s)
- Huijing Zhu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Endocrinology & Metabolism, Heze Municipal Hospital, Heze, Shandong, China
| | - Huili Wang
- Department of Endocrinology & Metabolism, Heze Municipal Hospital, Heze, Shandong, China
| | | | - Lin Cheng
- Department of Endocrinology & Metabolism, Heze Municipal Hospital, Heze, Shandong, China
| | - Xingbo Cheng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Suzhou, Jiangsu 215006, China
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Casula M, Olmastroni E, Galimberti F, Tragni E, Corrao G, Scotti L, Catapano AL. Association between the cumulative exposure to bisphosphonates and hospitalization for atherosclerotic cardiovascular events: A population-based study. Atherosclerosis 2020; 301:1-7. [PMID: 32289617 DOI: 10.1016/j.atherosclerosis.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Although bisphosphonates have been suggested to protect against atherosclerotic cardiovascular (CV) events, evidence is still conflicting. We aimed at investigating the effect of bisphosphonates on hospitalizations for atherosclerotic CV events. METHODS We carried out a retrospective cohort study selecting subjects aged>40 years, incident users of bisphosphonates. Exposure to bisphosphonates was characterized based on cumulative doses (proportion of days covered, PDC). Treatment's adherence was classified as low (PDC≤40%), intermediate (PDC 41%-80%), or high (PDC>80%). A multivariate Cox model was fitted to estimate the association between cumulative time-dependent exposure to bisphosphonates and hospitalization for atherosclerotic CV events (hazard ratio [HR] and 95% confidence interval). RESULTS Among 82,704 new bisphosphonates users (females 87.0%, mean age 70.7 ± 10.6 years), 16.1% had a CV hospitalization during a mean follow-up of 6.5 + 2.6 years. Compared with individuals with PDC ≤40%, those exposed for 41-80% or more than 80% showed HRs of CV hospitalization of 0.95 [0.91-0.99] and 0.75 [0.71-0.81], respectively. In the sub-analysis by type of event, a PDC >80% was associated with a reduced incidence for both coronary and cerebrovascular events (HRs 0.75 [0.68-0.83] and 0.76 [0.70-0.83], respectively). The protective effect was confirmed in stratified analyses by sex and age classes, and in those performed at 1 and 3 years of follow-up. CONCLUSIONS Strict adherence to bisphosphonate treatment was associated with a better CV outcome. Although further studies to investigate possible mechanisms are warranted, bisphosphonates could be considered as having a potential CV benefit beyond the effect on bones.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (Milan), Italy.
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Federica Galimberti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Lorenza Scotti
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (Milan), Italy
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