L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study
BackgroundCalcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated.MethodsThis prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999–2018). All-...
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Frontiers Media S.A.
2023-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2022.1097488/full |
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| author | Xinran Hou Jie Hu Zhuoyi Liu E. Wang Qulian Guo Zhong Zhang Zongbin Song Zongbin Song |
| author_facet | Xinran Hou Jie Hu Zhuoyi Liu E. Wang Qulian Guo Zhong Zhang Zongbin Song Zongbin Song |
| author_sort | Xinran Hou |
| collection | DOAJ |
| description | BackgroundCalcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated.MethodsThis prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999–2018). All-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality were obtained through linkage to the National Death Index. Survey-weighted multivariate Cox regression was performed to compute hazard ratios (HRs) and 95% confidential intervals (CIs) for the associations of calcium levels with risks of mortality. Restricted cubic spline analyses were performed to examine the non-linear association of calcium levels with all-cause and disease-specific mortality.ResultsA total of 51,042 individuals were included in the current study. During an average of 9.7 years of follow-up, 7,592 all-cause deaths were identified, including 2,391 CVD deaths and 1,641 cancer deaths. Compared with participants in the first quartile (Q1) of serum calcium level [≤2.299 mmol/L], the risk of all-cause mortality was lower for participants in the second quartile (Q2) [2.300–2.349 mmol/L], the third quartile (Q3) [2.350–2.424 mmol/L] and the fourth quartile (Q4) [≥2.425 mmol/L] with multivariable-adjusted HRs of 0.81 (95% CI, 0.74–0.88), 0.78 (95% CI, 0.71–0.86), and 0.80 (95% CI, 0.73, 0.88). Similar associations were observed for CVD mortality, with HRs of 0.82 (95% CI, 0.71–0.95), 0.87 (95% CI, 0.74–1.02), and 0.83 (95% CI, 0.72, 0.97) in Q2–Q4 quartile. Furthermore, the L-shaped non-linear associations were detected for serum calcium with the risk of all-cause mortality. Below the median of 2.350 mmol/L, per 0.1 mmol/L higher serum calcium was associated with a 24% lower risk of all-cause mortality (HR: 0.76, 95% CI, 0.70–0.83), however, no significant changes were observed when serum calcium was above the median. Similar L-shaped associations were detected for serum calcium with the risk of CVD mortality with a 25% reduction in the risk of CVD death per 0.1 mmol/L higher serum calcium below the median (HR: 0.75, 95% CI, 0.65–0.86).ConclusionL-shaped associations of serum calcium with all-cause and CVD mortality were observed in US adults, and hypocalcemia was associated with a higher risk of all-cause mortality and CVD mortality. |
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| spelling | doaj.art-5abab35c78c3482d9c68463a42013a112023-01-05T15:18:41ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2023-01-01910.3389/fnut.2022.10974881097488L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort studyXinran Hou0Jie Hu1Zhuoyi Liu2E. Wang3Qulian Guo4Zhong Zhang5Zongbin Song6Zongbin Song7Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Anesthesiology, Xiangya Hospital, Central South University, Changsha, ChinaNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, ChinaBackgroundCalcium is involved in many biological processes, but the impact of serum calcium levels on long-term mortality in general populations has been rarely investigated.MethodsThis prospective cohort study analyzed data from the National Health and Nutrition Examination Survey (1999–2018). All-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality were obtained through linkage to the National Death Index. Survey-weighted multivariate Cox regression was performed to compute hazard ratios (HRs) and 95% confidential intervals (CIs) for the associations of calcium levels with risks of mortality. Restricted cubic spline analyses were performed to examine the non-linear association of calcium levels with all-cause and disease-specific mortality.ResultsA total of 51,042 individuals were included in the current study. During an average of 9.7 years of follow-up, 7,592 all-cause deaths were identified, including 2,391 CVD deaths and 1,641 cancer deaths. Compared with participants in the first quartile (Q1) of serum calcium level [≤2.299 mmol/L], the risk of all-cause mortality was lower for participants in the second quartile (Q2) [2.300–2.349 mmol/L], the third quartile (Q3) [2.350–2.424 mmol/L] and the fourth quartile (Q4) [≥2.425 mmol/L] with multivariable-adjusted HRs of 0.81 (95% CI, 0.74–0.88), 0.78 (95% CI, 0.71–0.86), and 0.80 (95% CI, 0.73, 0.88). Similar associations were observed for CVD mortality, with HRs of 0.82 (95% CI, 0.71–0.95), 0.87 (95% CI, 0.74–1.02), and 0.83 (95% CI, 0.72, 0.97) in Q2–Q4 quartile. Furthermore, the L-shaped non-linear associations were detected for serum calcium with the risk of all-cause mortality. Below the median of 2.350 mmol/L, per 0.1 mmol/L higher serum calcium was associated with a 24% lower risk of all-cause mortality (HR: 0.76, 95% CI, 0.70–0.83), however, no significant changes were observed when serum calcium was above the median. Similar L-shaped associations were detected for serum calcium with the risk of CVD mortality with a 25% reduction in the risk of CVD death per 0.1 mmol/L higher serum calcium below the median (HR: 0.75, 95% CI, 0.65–0.86).ConclusionL-shaped associations of serum calcium with all-cause and CVD mortality were observed in US adults, and hypocalcemia was associated with a higher risk of all-cause mortality and CVD mortality.https://www.frontiersin.org/articles/10.3389/fnut.2022.1097488/fullserum calciummortalityall-causecardiovascular diseaseNational Health and Nutrition Examination Survey (NHANES) |
| spellingShingle | Xinran Hou Jie Hu Zhuoyi Liu E. Wang Qulian Guo Zhong Zhang Zongbin Song Zongbin Song L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study Frontiers in Nutrition serum calcium mortality all-cause cardiovascular disease National Health and Nutrition Examination Survey (NHANES) |
| title | L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study |
| title_full | L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study |
| title_fullStr | L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study |
| title_full_unstemmed | L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study |
| title_short | L-shaped association of serum calcium with all-cause and CVD mortality in the US adults: A population-based prospective cohort study |
| title_sort | l shaped association of serum calcium with all cause and cvd mortality in the us adults a population based prospective cohort study |
| topic | serum calcium mortality all-cause cardiovascular disease National Health and Nutrition Examination Survey (NHANES) |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2022.1097488/full |
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