Abstract 3033: Calcific Aortic Stenosis is Independently Associated With Increased Parathormone and Decreased Vitamin D Levels in Coronary Artery Disease Patients.
Introduction: In calcific aortic valve disease, the early sclerotic valve lesion is similar to the atherosclerotic arterial plaque, but at the later stage calcification with features of skeletal bone formation prevails. Parathormone (PTH) and vitamin D - endocrine system are the principal regulators of the calcium pool and bone mineral turnover.
Hypothesis: We hypothesized dysregulation of calcium-phosphate metabolism may be associated with advanced acquired calcific AS. Therefore, we aimed to assess the association of vitamin D and PTH plasma and serum levels, respectively, with aortic stenosis (AS) in patients with significant coronary artery disease (CAD).
Methods: We prospectively enrolled consecutive patients with angiographically significant CAD associated with AS (mean transvalvular aortic gradient ≥30 mm Hg), or nonobstructive aortic sclerosis (mean gradient ≤10 mmHg). We compared the fasting serum intact (i) PTH, plasma vitamin D level and calcium metabolism parameters between the two groups, and identified independent risk factors of AS.
Results: We included 122 patients with AS (85 males) and 101 patients with aortic sclerosis (76 males). The AS patients were older (71±7 vs 66±7 years; p<0.001), had higher iPTH level (57±26 vs 40±18 pg/ml; P<0.001), lower vitamin D level (34±12 vs 41±19 nmol/l; P=0.003), and lower creatinine clearance (67±24 ml/min vs 75±18 ml/min, P=0.04) than those with aortic sclerosis. Between both groups, there were no significant differences in the calcium phosphate product, occurrence of hypertension, smoking, diabetes, dyslipidemia, body mass index, and high sensitivity C-reactive protein level. The iPTH (OR 1.04, 95%CI 1.02–1.05; P<0.001), vitamin D levels (OR 0.97, 95% CI 0.95– 0.99; P=0.003), and age (OR 1.09, 95%CI 1.05–1.15; P<0.001) were independently associated with AS.
Conclusion: Increased serum iPTH and decreased plasma vitamin D levels were independently associated with calcific AS in CAD patients with preserved renal function. Our results suggest dysregulation of calcium-phoshate metabolism may be associated with valve calcification in these patients.