Association of serum calcium and heart failure with preserved ejection fraction in patients with type 2 diabetes

Abstract

BackgroundType 2 diabetes mellitus (T2DM) is a recognized trigger factor for heart failure with preserved ejection fraction (HFpEF). Recent studies show that higher serum calcium level is associated with greater risk of both T2DM and heart failure. We speculate that increased serum calcium is related to HFpEF prevalence in patients with T2DM.MethodsIn this cross-sectional echocardiographic study, 807 normocalcemia and normophosphatemia patients with T2DM participated, of whom 106 had HFpEF. Multinomial logistic regression was carried out to determine the variables associated with HFpEF. The associations between serum calcium and metabolic parameters, as well as the rate of HFpEF were examined using bivariate linear correlation and binary logistic regression, respectively. The predictive performance of serum calcium for HFpEF was evaluated using the area under the receiver operating characteristic curve (AUC).ResultsPatients with HFpEF have significantly higher serum calcium than those without HFpEF. Serum calcium was positively associated with total cholesterol, triglycerides, low-density lipoprotein cholesterol, serum uric acid, HOMA-IR and fasting plasma glucose. Compared with patients in the lowest serum calcium quartile, the odds ratio (OR) for HFpEF in patients in the highest quartile was 2.331 (95 % CI 1.088–4.994, p = 0.029). When calcium was analyzed as a continuous variable, per 1 mg/dL increase, the OR (95 % CI) for HFpEF was [2.712 (1.471–5.002), p = 0.001]. Serum calcium can predict HFpEF [AUC = 0.673, 95 % CI (0.620–0.726), p < 0.001].ConclusionsAn increase in serum calcium level is associated with an increased risk of HFpEF in patients with T2DM.

Risk of bias in studies investigating novel diagnostic biomarkers for heart failure with preserved ejection fraction. A systematic review

“…The 28 selected studies included a wide range of potential novel diagnostic HFpEF circulating biomarkers ( Table 1 ). 22–49 …”

Admission blood glucose and 10-year mortality among patients with or without pre-existing diabetes mellitus hospitalized with heart failure

“…First, hyperglycemia promotes anaerobic myocardial metabolism, inhibits production of nitric oxide and increases the production of reactive oxygen species in endothelial and vascular smooth muscle cells, thus impairing endothelial function [ 42 , 43 ]. Second, hyperglycemia alters cardiac structure through post-translational modification of extracellular matrix, both leading to impaired relaxation and increased ventricular stiffness and alters calcium metabolism [ 44 – 48 ]. Finally, insulin deficiency is associated with increased lipolysis and excess circulating free fatty acids, which are toxic to ischemic myocardium and were shown to be associated with the development of arrhythmias [ 49 ].…”

Higher serum phosphorus and calcium levels provide prognostic value in patients with acute myocardial infarction

“…In our study, we first found that there was an independent association between higher corrected serum calcium levels and the increased risk of in-hospital HF in AMI population. In prior studies, higher serum calcium was independently related to HF risk in a community-based cohort study ( 11 ), and elevated serum calcium levels were an independent risk factor for HFpEF in patients with type 2 diabetes mellitus (T2DM) ( 29 ). Some potential mechanisms may contribute to the association.…”