PT  - JOURNAL ARTICLE
AU  - Norma Christine Grandi
AU  - Hermann Brenner
AU  - Harry Hahmann
AU  - Bernd Wüsten
AU  - Winfried März
AU  - Dietrich Rothenbacher
AU  - Lutz Philipp Breitling
TI  - Calcium, phosphate and the risk of cardiovascular events and all-cause mortality in a population with stable coronary heart disease
AID  - 10.1136/heartjnl-2011-300806
DP  - 2012 Jun 15
TA  - Heart
PG  - 926--933
VI  - 98
IP  - 12
4099  - http://heart.bmj.com/content/98/12/926.short
4100  - http://heart.bmj.com/content/98/12/926.full
SO  - Heart2012 Jun 15; 98
AB  - Objective High serum calcium and phosphate levels have been linked to cardiovascular diseases and all-cause mortality but evidence from longitudinal studies is scarce, especially among patients with pre-existing coronary heart disease. The association between baseline calcium and phosphate and prognosis was examined in a cohort study of patients with stable coronary heart disease.Methods Serum calcium and phosphate were measured in a cohort of initially 1206 patients undergoing a 3 week rehabilitation programme after an acute cardiovascular event and subsequently being followed-up for 8 years. Multivariate Cox regression was employed to assess the association of quartiles and continuous levels of calcium and phosphate with secondary cardiovascular events and all-cause mortality.Results No significant risk elevations were observed for secondary cardiovascular event incidence in models adjusted for a variety of potential confounders. High calcium levels, however, were strongly associated with mortality risk in adjusted models (HRQ4vsQ1=2.39 (1.22 to 4.66)). In additional multivariable analyses, the calcium/albumin ratio was predictive for all-cause mortality (HRQ4vsQ1=2.66 (1.35 to 5.22)) and marginally predictive for cardiovascular event incidence (HRQ4vsQ1=1.74 (1.00 to 3.05)).Conclusions Calcium and the ratio of calcium with albumin, its major binding protein, were strongly associated with all-cause mortality among patients with coronary heart disease. The underlying mechanisms and the clinical implications of these findings deserve further study.