Cross-sectional analysis of serum calcium levels for associations with left ventricular hypertrophy in normocalcemia individuals with type 2 diabetes

Abstract

BackgroundLeft ventricular hypertrophy (LVH) is prevalent in patients with type 2 diabetes mellitus (T2DM). Recent studies show that an increase in albumin-adjusted serum calcium level is associated with an elevated risk of T2DM. We speculate that increased serum calcium levels in T2DM patients are related to LVH prevalence.MethodsIn this echocardiographic study, 833 normocalcemia and normophosphatemia patients with T2DM were enrolled. The associations between serum calcium and metabolic parameters, left ventricular mass index (LVMI), as well as the rate of LVH were examined using bivariate linear correlation, multivariate linear regression and logistic regression, respectively. The predictive performance of serum calcium for LVH was evaluated using the area under the receiver operating characteristic curve (AUC).ResultsPatients with LVH have significantly higher serum calcium than those without LVH. Serum calcium was positively associated with total cholesterol, triglycerides, low-density lipoprotein cholesterol, serum uric acid, HOMA-IR and fasting plasma glucose. Multivariate linear regression analysis demonstrated that serum calcium was independently associated with LVMI (p < 0.001). In comparison with patients in the lowest serum calcium quartile, the odds ratio (OR) for LVH in patients in the highest quartile was 2.909 (95% CI 1.792-4.720; p < 0.001). When serum calcium was analyzed as a continuous variable, per 1 mg/dl increase, the OR (95% CI) for LVH was [2.400 (1.552-3.713); p < 0.001]. Serum calcium can predict LVH (AUC = 0.617; 95% CI (0.577-0.656); p < 0.001).ConclusionsAlbumin-adjusted serum calcium is associated with an increased risk of LVH in patients with T2DM.

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

“…As a key pathophysiological mechanism of T2DM, insulin resistance is not only accompanied with an increase in intracellular calcium [ 34 , 35 ], but also positively correlated with serum calcium level in ours and other studies [ 33 , 36 , 37 ]. Meanwhile, there is increasing awareness regarding the associations of insulin resistance with myocardial diastolic dysfunction, cardiomyopathy and heart failure [ 21 , 38 , 39 ].…”

“…Though eccentric hypertrophy can occur in HFpEF, ours and previous studies [ 3 , 32 ] demonstrate that concentric hypertrophy is the common form of left ventricular structural abnormality observed in these patients. Furthermore, in patients with T2DM, serum calcium is associated with an increased risk of LVH [ 33 ]. In accord with these, patients in our study with concentric hypertrophy had a higher but not significant level of serum calcium (9.13 ± 0.40 vs. 9.05 ± 0.42 mg/dL, p = 0.083) and a greater percentage of HFpEF (28.7 vs. 16.7 %, p = 0.014) than those with eccentric hypertrophy; however, after adjusted for LVMI (the index for LVH), serum calcium remained significantly associated with HFpEF (Table 5 ).…”

Circulating calcium concentrations, vascular disease and mortality: a systematic review

“…This finding is consistent with the report from Li et al . that adjusted serum calcium is associated with an increased risk of left ventricular hypertrophy in patients with type 2 diabetes.…”

Association of serum calcium concentrations with fibrinogen and homocysteine in non-diabetic Korean subjects

“…[11] Previous studies reported that high normal calcium levels are associated with greater pulse wave velocity in 9165 Chinese subjects, [18] carotid plaque thickness in 1194 multiethnic subjects, [19] and increased risk of left ventricular hypertrophy in 833 Chinese diabetic subjects. [20] Recent data from a longitudinal study of 1507 middle-aged Japanese men, which found changes in brachialankle pulse wave velocity during a 3-year follow-up period, further highlight the possibility that increased serum calcium may be involved in the pathogenesis of atherothrombosis. [21] The biological mechanisms underlying the association between serum calcium concentrations and increased prothrombotic markers are unclear, but there may be several explanations.…”