Relationship between calcium-phosphorus product and severity of valvular heart insufficiency in patients undergoing chronic hemodialysis

Recent interests have mainly focused on the roles of serum calcium and phosphorus and their product [Ca-P product] in the development of valvular heart disease. The present study assessed the relationship between the Ca-P product and the severity of valvular heart disease in end-stage renal disease [ESRD] patients undergoing chronic hemodialysis. This cross-sectional study reviewed the clinical course of 72 consecutive patients with the final diagnosis of ESRD candidated for chronic hemodialysis. The severity of valvular heart disease was determined using M-mode two-dimensional echocardiography. The serum calcium and phosphate values adopted were those values measured on the day between the two consecutive dialyses, and the Ca-P product was calculated. The most common causes of ESRD were diabetic nephropathy, malignant hypertension, and chronic glomerulonephritis. The mean Ca-P product level in the dialysis patients was 50.44 +/- 17.78 mg2/dL2. The receiver-operator characteristic [ROC] curve illustrated that a Ca-P product level>42 mg2/dL2 was the optimal value in terms of sensitivity and specificity for predicting the presence of valvular insufficiency. Aortic insufficiency was directly associated with a high Ca-P product value after adjustment for age, gender, serum albumin, diabetes, hypertension, hyperlipidemia, coronary artery disease, and serum creatinine [P=0.412, SE=158, p value=0.011]. A positive relationship between the Ca-P product value and the severity of aortic insufficiency is expected. Achieving an appropriate control of the Ca-P product level may decrease aortic valve calcification and improve the survival of patients on chronic hemodialysis

Plasma homocysteine concentrations in young patients with acute myocardial infarction

Most studies indicate that increased plasma homocysteine level is a risk factor for coronary artery disease. However, data concerning the role of homocysteine in young patients with acute myocardial infarction [AMI] is scanty. The aim of this study was to study the possible association between homocysteine plasma levels and early-onset AMI. This case-control study included 83 AMI patients and 83 healthy controls. Biochemical parameters were determined and homocysteine was measured by enzyme immunoassay. Multivariate logistic regression analysis was used to test the association of homocysteine with the occurrence of AMI Homocysteine concentration in patients with AMI was higher than in controls [19.54 +/- 13.3 and 15.54 +/- 8.9 micro mol/l, respectively, P=0.002]. Hyperhomocysteinemia was associated with early myocardial infarction [odds ratio=5.05]. Hypercholesterolemia [OR=4/21], opium addiction [OR=4/78] and age [OR=1/24] also had associations with AMI. Our results showed that homocysteine levels are elevated in young patients with AMI, and hyperhomocysteinemia is associated with early myocardial infarction; hence it should be evaluated in all young patients with AMI