Clinical Research
Valve Disease
Association of Serum Phosphate Levels With Aortic Valve Sclerosis and Annular Calcification: The Cardiovascular Health Study

https://doi.org/10.1016/j.jacc.2010.11.073Get rights and content
Under an Elsevier user license
open archive

Objectives

This study was conducted to evaluate mineral metabolism markers as potential risk factors for calcific aortic valve disease.

Background

Mineral metabolism disturbances are common among older people and may contribute to cardiac valvular calcification. Associations of serum mineral metabolism markers with cardiac valvular calcification have not been evaluated in a well-characterized general population of older adults.

Methods

We measured serum levels of phosphate, calcium, parathyroid hormone, and 25-hydroxyvitamin D in 1,938 Cardiovascular Health Study participants who were free of clinical cardiovascular disease and who underwent echocardiographic measurements of aortic valve sclerosis (AVS), mitral annular calcification (MAC), and aortic annular calcification (AAC). We used logistic regression models to estimate associations of mineral metabolism markers with AVS, MAC, and AAC after adjustment for relevant confounding variables, including kidney function.

Results

The respective prevalences of AVS, MAC, and AAC were 54%, 39%, and 44%. Each 0.5 mg/dl higher serum phosphate concentration was associated with greater adjusted odds of AVS (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.04 to 1.31, p = 0.01), MAC (OR: 1.12, 95% CI: 1.00 to 1.26, p = 0.05), and AAC (OR: 1.12, 95% CI: 0.99 to 1.25, p = 0.05). In contrast, serum calcium, parathyroid hormone, and 25-hydroxyvitamin D concentrations were not associated with aortic or mitral calcification.

Conclusions

Higher serum phosphate levels within the normal range were associated with valvular and annular calcification in a community-based cohort of older adults. Phosphate may be a novel risk factor for calcific aortic valve disease and warrants further study.

Key Words

aortic valve
calcification
epidemiology
mitral valve
phosphate

Abbreviations and Acronyms

25-OHD
25-hydroxyvitamin D
AAC
aortic annular calcification
AVS
aortic valve sclerosis
CAVD
calcific aortic valve disease
CKD
chronic kidney disease
eGFR
estimated glomerular filtration rate
LDL
low-density lipoprotein
MAC
mitral annular calcification
PTH
parathyroid hormone

Cited by (0)

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. The research reported in this article was supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, and N01-HC-45133, and grant number U01 HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additionally, the research reported here was supported by the Department of Veterans Affairs Health Services Research and Development Service, TPM 61-034. Funding for this study was also provided by National Institutes of Health R01 HL084443 and R01 AG 027002. Dr. O'Brien has received honoraria from AstraZeneca and Merck. The other authors have reported that they have no relationships to disclose. Dr. Linefsky is presently the post doc fellow at the Veterans Affairs Health Services Research and Development Northwest Center for Excellence.