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.
Highlights
Type 2 diabetes mellitus (T2DM) is a recognized trigger factor for heart failure with preserved ejection fraction (HFpEF)
Serum calcium and metabolism‐related parameters Bivariate linear correlation analysis showed that albumin-adjusted serum calcium level was significantly and positively correlated with metabolism-related parameters including fasting plasma glucose (FPG) (r = 0.205, p < 0.001), lg HOMA-IR (r = 0.143, p < 0.001), uric acid (r = 0.175, p < 0.001), TG (r = 0.104, p = 0.003), total cholesterol (TC) (r = 0.125, p < 0.001) and lowdensity lipoprotein cholesterol (LDL-C) (r = 0.099, p = 0.005) (Table 2)
To determine the variables associated with HFpEF, backward stepwise multinomial logistic regression analysis was developed to include albumin-adjusted serum calcium, serum phosphate, age, gender, body mass index (BMI), LVM index (LVMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), TC, TG, high-density lipoprotein cholesterol (HDL-C), LDL-C, smoking, lg albumin per gram urine creatinine (Alb/Cr), lg HOMA-IR, uric acid and HbA1c on first step
Summary
Type 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. Li et al Cardiovasc Diabetol (2016) 15:140 is independently associated with increased risk of T2DM [9, 10] and cardiovascular disease [11] even in normocalcemic populations. Based on these findings, we speculate that an alteration in serum calcium is associated with HFpEF prevalence, and we conduct a cross-sectional study to evaluate relationships between serum calcium levels and HFpEF in T2DM patients
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