Highlights
- •Calcific aortic valve disease (CAVD) is the most common heart valve disease worldwide.
- •Subclinical early stage of CAVD is characterized by aortic valve calcification (AVC).
- •Our population-based study examined relations of serum micronutrients levels to AVC prevalence, incidence, and progression.
- •Serum magnesium were inversely related, while serum phosphorus were positively related, to AVC prevalence or incidence.
- •Serum micronutrients may be potential candidates for risk prediction or prevention of CAVD and warrant further studies.
Abstract
Background and aims
Calcific aortic valve disease (CAVD) is the most common valve disease. Although micronutrients
are known to contribute to cardiovascular disease, the relationship with CAVD remains
poorly evaluated. We examined the association of serum levels of magnesium, phosphorus,
and calcium with prevalence, incidence, and progression of aortic valve calcification
(AVC).
Methods
We conducted a prospective study in a population-based sample of Japanese men aged
40–79 years without known cardiovascular disease and chronic kidney disease at baseline,
and quantified AVC from serial computed tomographic images with the Agatston method.
Results
Of 938 participants at baseline (mean age, 63.7 ± 9.9 years), AVC prevalence was observed
in 173 (18.4%). Of 596 participants without baseline AVC at follow-up (median duration,
5.1 years), AVC incidence was observed in 138 (23.2%). After adjustment for demographics,
behaviors and cardiovascular risk factors, relative risks (95% confidence intervals)
in the highest versus lowest categories of serum magnesium, phosphorus, and calcium were 0.62 (0.44–0.86),
1.45 (1.02–2.04), and 1.43 (0.95–2.15), respectively, for AVC prevalence and 0.62
(0.42–0.92), 1.93 (1.28–2.91), and 1.09 (0.77–1.55), respectively, for AVC incidence.
Their linear trends of serum magnesium and phosphorus were also all statistically
significant. Of 131 participants with baseline AVC, there was no association of any
serum micronutrients with AVC progression.
Conclusions
Serum magnesium was inversely associated, while serum phosphorus was positively associated
with AVC prevalence and incidence, suggesting that these serum micronutrients may
be potential candidates for risk prediction or prevention of CAVD, and warranting
further studies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The lipid hypothesis in calcific aortic valve disease: the role of the Multi-Ethnic Study of Atherosclerosis.Arterioscler. Thromb. Vasc. Biol. 2016; 36: 774-776
- Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the national heart and lung and blood institute aortic stenosis working group. Executive summary: calcific aortic valve disease-2011 update.Circulation. 2011; 124: 1783-1791
- Aortic valve calcium independently predicts coronary and cardiovascular events in a primary prevention population.JACC Cardiovasc Imaging. 2012; 5: 619-625
- Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly.N. Engl. J. Med. 1999; 341: 142-147
- Accurate assessment of aortic stenosis: a review of diagnostic modalities and hemodynamics.Circulation. 2014; 129: 244-253
- Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies.Circulation. 2005; 111: 3316-3326
- Degenerative calcific aortic stenosis: a natural history.Heart. 2012; 98 (iv7-13)
- Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis.N. Engl. J. Med. 2008; 359: 1343-1356
- ASTRONOMER Investigators. Effect of lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial.Circulation. 2010; 121: 306-314
- Is low magnesium concentration a risk factor for coronary heart disease? The Atherosclerosis Risk in Communities (ARIC) study.Am. Heart J. 1998; 136: 480-490
- Dietary and plasma magnesium and risk of coronary heart disease among women.J Am Heart Assoc. 2013; 2: e000114
- Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies.Am. J. Clin. Nutr. 2013; 98: 160-173
- Calcium-phosphate levels and cardiovascular disease in community-dwelling adults: the Atherosclerosis Risk in Communities (ARIC) study.Am. Heart J. 2008; 156: 556-563
- Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community.Arch. Intern. Med. 2007; 167: 879-885
- Impact of serum calcium and phosphate on coronary atherosclerosis detected by cardiac computed tomography.Eur. Heart J. 2012; 33: 2873-2881
- Magnesium and cardiovascular system.Magnes. Res. 2010; 23: 60-72
- Magnesium.Informa Healthcare, New York, NY2010
- Serum phosphorus levels associate with coronary atherosclerosis in young adults.J. Am. Soc. Nephrol. 2009; 20: 397-404
- Cardiovascular effects of calcium supplementation.Osteoporos. Int. 2011; 22: 1649-1658
- Association of serum phosphate levels with aortic valve sclerosis and annular calcification: the cardiovascular health study.J. Am. Coll. Cardiol. 2011; 58: 291-297
- Serum phosphate is associated with aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis (MESA).Atherosclerosis. 2014; 233: 331-337
- Interaction of age with lipoproteins as predictors of aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis.Arch. Intern. Med. 2008; 168: 1200-1207
- Relationship of insulin resistance to prevalence and progression of coronary artery calcification beyond metabolic syndrome components: Shiga Epidemiological Study of Subclinical Atherosclerosis.Arterioscler. Thromb. Vasc. Biol. 2016; 36: 1703-1708
- Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.Clin. Chem. 1972; 18: 499-502
- GFR estimation using standardized serum cystatin C in Japan.Am. J. Kidney Dis. 2013; 61: 197-203
- International clinical harmonization of glycated hemoglobin in Japan from Japan diabetes society to national glycohemoglobin standardization program values.J Diabetes Invest. 2012; 3: 39-40
- Smoking, smoking cessation, and measures of subclinical atherosclerosis in multiple vascular beds in Japanese men.J Am Heart Assoc. 2016; 5: e003738
- Quantification of coronary artery calcium using ultrafast computed tomography.J. Am. Coll. Cardiol. 1990; 15: 827-832
- Features of the metabolic syndrome and diabetes mellitus as predictors of aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis.Circulation. 2006; 113: 2113-2119
- Incidence and progression of aortic valve calcium in the Multi-Ethnic Study of Atherosclerosis (MESA).Am. J. Cardiol. 2010; 105: 701-708
- Relationship of metabolic syndrome with incident aortic valve calcium and aortic valve calcium progression: the Multi-Ethnic Study of Atherosclerosis (MESA).Diabetes. 2009; 58: 813-819
- Reproducibility of ct measurements of aortic valve calcification, mitral annulus calcification, and aortic wall calcification in the Multi-Ethnic Study of Atherosclerosis.Acad. Radiol. 2006; 13: 166-172
- Effect of scanner type on the reproducibility of extracoronary measures of calcification: the Multi-Ethnic Study of Atherosclerosis.Acad. Radiol. 2007; 14: 1043-1049
- A modified Poisson regression approach to prospective studies with binary data.Am. J. Epidemiol. 2004; 159: 702-706
- Characterization of the early lesion of 'degenerative' valvular aortic stenosis. Histological and immunohistochemical studies.Circulation. 1994; 90: 844-853
- Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease? Insights from a population-based study.J. Am. Coll. Cardiol. 2001; 38: 827-834
- Magnesium deficiency promotes a pro-atherogenic phenotype in cultured human endothelial cells via activation of NFkB.Biochim. Biophys. Acta. 2010; 1802: 952-958
- Comparative angioprotective effects of magnesium compounds.J. Trace Elem. Med. Biol. 2015; 29: 227-234
- Serum Inorganic Phosphorus.Butterworths, Boston, MA1990
- Human aortic valve calcification is associated with an osteoblast phenotype.Circulation. 2003; 107: 2181-2184
- Serum phosphorus concentrations in the third national health and nutrition examination survey (NHANES III).Am. J. Kidney Dis. 2009; 53: 399-407
- Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets.Kidney Int. 2012; 81: 1116-1122
- Low dietary magnesium increases supraventricular ectopy.Am. J. Clin. Nutr. 2002; 75: 550-554
- Effects of oral magnesium supplementation on glycaemic control in type 2 diabetes: a meta-analysis of randomized double-blind controlled trials.Diabet. Med. 2006; 23: 1050-1056
- Update on the assessment of magnesium status.Br. J. Nutr. 2008; 99: S24-S36
- Daily magnesium intake and serum magnesium concentration among Japanese people.J. Epidemiol. 2008; 18: 151-159
Article info
Publication history
Published online: March 22, 2018
Accepted:
March 21,
2018
Received in revised form:
February 22,
2018
Received:
September 7,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Cardiovascular calcification: The emerging role of micronutrientsAtherosclerosisVol. 273
- PreviewIn this issue of Atherosclerosis, Hisamatsu and coworkers [1] contribute to expand our current knowledge on the association of nutrients with aortic valve calcification (AVC). AVC is the most frequent valvular disease and, in its most advanced stage, is associated with a poor outcome [2]. Although some ethnic differences exist, its prevalence increases with age, and up to 13% of the individuals over age 65 years present some degree of calcification of the aortic valve leaflets [2]. Interestingly, a poor clinical outcome has been reported irrespective of echocardiographic and hemodynamic parameters, and the presence of AVC represents an independent predictor of cardiovascular (CV) events [3].
- Full-Text
- Preview
