Research Article| Volume 273, P145-152, June 2018

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Serum magnesium, phosphorus, and calcium levels and subclinical calcific aortic valve disease: A population-based study


      • 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.


      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).


      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.


      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.


      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.


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      Linked Article

      • Cardiovascular calcification: The emerging role of micronutrients
        AtherosclerosisVol. 273
        • Preview
          In 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].
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