[논문]Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults

Jung-Ho Yang; Sun-Seog Kweon; Young-Hoon Lee; Seong-Woo Choi; So-Yeon Ryu; Hae-Sung Nam; Hye-Yeon Kim; Min-Ho Shin

doi:10.3961/jpmph.23.068

Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults 원문보기

Journal of preventive medicine and public health = 예방의학회지, v.56 no.3, 2023년, pp.282 - 290

Jung-Ho Yang (Department of Preventive Medicine, Chonnam National University Medical School) , Sun-Seog Kweon (Department of Preventive Medicine, Chonnam National University Medical School) , Young-Hoon Lee (Department of Preventive Medicine & Institute of Wonkwang School of Medicine, Wonkwang University School of Medicine) , Seong-Woo Choi (Department of Preventive Medicine, Chosun University College of Medicine) , So-Yeon Ryu (Department of Preventive Medicine, Chosun University College of Medicine) , Hae-Sung Nam (Department of Preventive Medicine, Chungnam National University College of Medicine) , Hye-Yeon Kim (Department of Preventive Medicine, Chonnam National University Medical School) , Min-Ho Shin (Department of Preventive Medicine, Chonnam National University Medical School)

Abstract ▼ AI-Helper

Objectives: This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality. Methods: This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: 97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate. Results: Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (97.5th: HR, 1.65; 95% CI, 0.70 to 3.93). Conclusions: We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.

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표 Table 1. Baseline characteristics of the study population according to the serum calcium concentration-based categories
그림 Figure 1. HRs of cardiovascular mortality according to adjusted serum calcium levels and kidney function status. Ref, reference value; HR, hazard ratio; eGFR, estimated glomerular filtration rate. HR were estimated using the restricted cubic spline model of 4 knots adjusted for age, sex, education level, physical activity, smoking status, drinking status, body mass index, comorbidities (diabetes, hypertension), and total cholesterol. The rug plot represents the distribution of adjusted serum calcium levels.
표 Table 2. Adjusted HRs for cardiovascular mortality according to adjusted serum calcium levels¹

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Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults 원문보기

Abstract ▼ AI-Helper

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표/그림 (3)

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