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Racial Differences in Association of Serum Calcium with Mortality and Incident Cardio- and Cerebrovascular Events
Jun Ling Lu1, Miklos Z Molnar1, Jennie Z Ma1
1Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104.
Insights
Race impacts how serum calcium levels affect mortality risk. African American individuals had lower mortality with higher calcium, while white individuals had higher mortality. Calcium did not affect cardiovascular events.
Area of Science:
- Cardiovascular Disease Epidemiology
- Calcium Metabolism Research
- Racial Disparities in Health
Background:
- Abnormalities in calcium metabolism are linked to vascular disease development.
- Differences in calcium metabolism between African American (AA) and white individuals are suggested, but their impact on clinical outcomes is unclear.
Purpose of the Study:
- To investigate race-specific associations between serum calcium levels and mortality.
- To examine race-specific associations between serum calcium levels and major incident cardiovascular events.
Main Methods:
- A historical cohort study was conducted within U.S. Department of Veterans Affairs facilities.
- Data from 1,967,622 veterans with estimated glomerular filtration rate ≥ 60 mL/min/1.73 m² were analyzed.
- Multivariable adjusted Cox proportional hazards models, including a calcium-race interaction term, assessed associations with all-cause mortality, coronary heart disease (CHD), and ischemic stroke.
Main Results:
- A U-shaped association between calcium and all-cause mortality was observed in both AA and white patients.
- Race significantly modified the calcium-mortality association: AA patients had lower mortality risk with calcium ≥ 8.8 mg/dL compared to white patients (P < .001).
- Higher mortality was observed in AA versus white patients when calcium was < 8.8 mg/dL. No significant associations were found between calcium and ischemic stroke or CHD for either race.
Conclusions:
- The association between calcium and all-cause mortality is modified by race.
- Serum calcium levels are not significantly associated with incident stroke or CHD in either AA or white patients.
- Further research is warranted to understand the race-specific differences in calcium's association with mortality.
Context:
Abnormalities in calcium metabolism may potentially contribute to the development of vascular disease. Calcium metabolism may be different in African American (AA) vs white individuals, but the effect of race on the association of serum calcium with clinical outcomes remains unclear.
Objective:
This study sought to examine race-specific associations of serum calcium levels with mortality and with major incident cardiovascular events.
Design And Setting:
This was a historical cohort study in the U.S. Department of Veterans Affairs health care facilities.
Participants:
Participants included veterans (n = 1 967 622) with estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2.
Main Outcome Measures:
The association between serum calcium levels with all-cause mortality, incident coronary heart disease (CHD), and ischemic stroke incidence was examined in multivariable adjusted Cox proportional hazards models, including an interaction term for calcium and race.
Results:
The association of calcium with all-cause mortality was U-shaped in both AA and white patients, but race modified the association of calcium with all-cause mortality. Compared with white patients, AA patients experienced lower risk of mortality when calcium was ≥ 8.8 mg/dL, with a statistically significant interaction (P < .001). Conversely, AA vs white race was associated with higher mortality when calcium was < 8.8 mg/dL. Calcium showed no significant association with ischemic stroke or CHD in both races; and race did not modify these associations (P = .37 and 0.11, respectively for interaction term).
Conclusions:
Race modified the U-shaped association between calcium and all-cause mortality. Serum calcium is not associated with incident stroke or CHD in either AA or white patients. The race-specific difference in the association of calcium levels with mortality warrants further examination.
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