Association between Serum Calcium and First Incident Acute Myocardial Infarction: A Cross-Sectional Study
Background: The role of serum calcium in coronary artery disease (CAD) patients with or without first incident acute myocardial infarction has not been studied previously. This study aimed to assess the relationship between serum calcium and first incident acute myocardial infarction.
Methods: This cross-sectional study was conducted from Jan 2014 to Dec 2016. All the participants were from our database, described in detail elsewhere including 1609 cases and 3252 controls. Multiple logistic regression was carried out to explore the effect of serum calcium on first incident acute myocardial infarction. Interaction between serum calcium and risk factors were evaluated.
Results: Patients with first incident acute myocardial infarction have significantly lower serum calcium concentrations than those without acute myocardial infarction (2.18 (0.21) vs 2.24 (0.19) mmol/L, P<0.0001). After adjusting for sex and age, logistic regression showed that serum calcium was significantly associated with first incident acute myocardial infarction (odds ratio (OR): 1.50, 95% confidence interval (CI): 1.41-1.60). Further adjusted for potential confounders, serum calcium was associated with first incident acute myocardial infarction (OR: 1.32, 95% CI: 1.22-1.42). Moreover, the association still existed when patients were divided into subgroups according to gender and age. A significant interaction was found between serum calcium and diabetes mellitus (DM), lipoprotein (a) (Lp (a)), and serum albumin.
Conclusion: Serum calcium was associated with first incident acute myocardial infarction among CAD patients in both sexes and in age categories. This study provides further evidence showing the value of serum calcium levels in clinical practice.
Fihn SD (2014). Bending the curve on cardiovascular risk. JAMA Intern Med, 174(1): 48-50.
Wang W, Hu SS, Kong LZ, Gao RL, Zhu ML, et al. (2014). Summary of report on cardiovascular diseases in China, 2012. Biomed Environ Sci, 27(7): 552-8.
(2016). Cardiovascular disease in Europe 2016: an epidemiological update. Eur Heart J, 37(42): 3182-83.
Wang Y, Ma H, Hao X, Yang J, Chen Q, et al. (2016). Low serum calcium is associated with left ventricular systolic dysfunction in a Chinese population with coronary artery disease. Sci Rep, 622283.
Bristow SM, Gamble GD, Stewart A, Horne AM, Reid IR (2015). Acute effects of calcium supplements on blood pressure and blood coagulation: secondary analysis of a randomised controlled trial in post-menopausal women. Br J Nutr, 114(11): 1868-74.
Eisner D (2017). Ups and downs of calcium in the heart. J Physiol.
Eisner D, Bode E, Venetucci L, Trafford A (2013). Calcium flux balance in the heart. J Mol Cell Cardiol, 58110-7.
Yan SD, Liu XJ, Peng Y, Xia TL, Liu W, et al. (2016). Admission Serum Calcium Levels Improve the GRACE Risk Score Prediction of Hospital Mortality in Patients With Acute Coronary Syndrome. Clin Cardiol, 39(9): 516-23.
Lu X, Wang Y, Meng H, Chen P, Huang Y, et al. (2014). Association of admission serum calcium levels and in-hospital mortality in patients with acute ST-elevated myocardial infarction: an eight-year, single-center study in China. PLoS One, 9(6): e99895.
Lewis JR, Radavelli-Bagatini S, Rejnmark L, Chen JS, Simpson JM, et al. (2015). The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res, 30(1): 165-75.
Paik JM, Curhan GC, Sun Q, Rexrode KM, Manson JE, et al. (2014). Calcium supplement intake and risk of cardiovascular disease in women. Osteoporos Int, 25(8): 2047-56.
Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, et al. (2010). Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ, 341c3691.
Chung M, Tang AM, Fu Z, Wang DD, Newberry SJ (2016). Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med, 165(12): 856-66.
Cai DP, He YM, Yang XJ, Zhao X, Xu HF (2015). Lipoprotein (a) is a risk factor for coronary artery disease in Chinese Han ethnic population modified by some traditional risk factors: A cross-sectional study of 3462 cases and 6125 controls. Clin Chim Acta, 451(Pt B): 278-86.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, et al. (2012). Third universal definition of myocardial infarction. Circulation, 126(16): 2020-35.
Jorde R, Sundsfjord J, Fitzgerald P, Bonaa KH (1999). Serum calcium and cardiovascular risk factors and diseases: the Tromso study. Hypertension, 34(3): 484-90.
Dahlen G, Ericson C, Berg K (1978). In vitro studies of the interaction of calcium ions and other divalent cations with the Lp(a) lipoprotein and other isolated serum lipoproteins. Clin Genet, 14(2): 115-24.
Tong X, Dong JY, Wu ZW, Li W, Qin LQ (2011). Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J Clin Nutr, 65(9): 1027-31.
Martin NH, Perkins DJ (1950). The interaction of serum albumins with calcium. Biochem J, 47(3): 323-6.
Lam V, Dhaliwal SS, Mamo JC (2013). Adjustment of ionized calcium concentration for serum pH is not a valid marker of calcium homeostasis: implications for identifying individuals at risk of calcium metabolic disorders. Ann Clin Biochem, 50(Pt 3): 224-9.
Yao Y, He L, Jin Y, Chen Y, Tang H, et al. (2013). The relationship between serum calcium level, blood lipids, and blood pressure in hypertensive and normotensive subjects who come from a normal university in east of China. Biol Trace Elem Res, 153(1-3): 35-40.
Reid IR, Mason B, Horne A, Ames R, Clearwater J, et al. (2002). Effects of calcium supplementation on serum lipid concentrations in normal older women: a randomized controlled trial. Am J Med, 112(5): 343-7.
Bjorkman MP, Sorva AJ, Tilvis RS (2009). Calculated serum calcium is an insufficient surrogate for measured ionized calcium. Arch Gerontol Geriatr, 49(3): 348-50.
Ridefelt P, Helmersson-Karlqvist J (2017). Albumin adjustment of total calcium does not improve the estimation of calcium status. Scand J Clin Lab Invest, 77(6): 442-47.
Slomp J, van der Voort PH, Gerritsen RT, Berk JA, Bakker AJ (2003). Albumin-adjusted calcium is not suitable for diagnosis of hyper- and hypocalcemia in the critically ill. Crit Care Med, 31(5): 1389-93.