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

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: Aortic valve disease; Calcification; Epidemiology; Magnesium; Phosphorus; Prospective study.

Figure 1. Association of demographics, behavioral and cardiovascular risk factors, and serum micronutrients with AVC prevalence

Circle markers and horizontal lines indicate relative risks and 95% CI for AVC prevalence, respectively. Relative risks for continuous variables are expressed as per 1 standard deviation higher in values of each factor, with the following exception: pack-year smoking and C-reactive protein (per 1-log higher). All variables listed were mutually adjusted and further adjusted for computed tomography type. AVC, aortic valve calcification; CI, confidence interval; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Figure 2. Association of demographics, behavioral and cardiovascular risk factors, and serum micronutrients with AVC incidence

Circle markers and horizontal lines indicate relative risks and 95% CI for AVC incidence, respectively. Relative risks for continuous variables are expressed as per 1 standard deviation higher in values of each factor, with the following exception: pack-year smoking and C-reactive protein (per 1-log higher). All variables listed were mutually adjusted and further adjusted for computed tomography type and follow-up duration. Abbreviations are shown in Fig. 1.