Association of serum calcium and phosphorus with measures of left ventricular structure and function: The ARIC study

Nutr Metab Cardiovasc Dis. 2020 May 7;30(5):758-767. doi: 10.1016/j.numecd.2020.01.003. Epub 2020 Jan 21.


Background and aims: Elevated serum calcium and phosphorus have been associated with increased risk of cardiovascular disorders. We evaluated whether abnormal calcium and high serum phosphorus are associated cross-sectionally with echocardiographic measures of left ventricular (LV) structure and function, as doing so may provide insight into the etiology of cardiac disorders.

Methods and results: Included in the analysis were 5213 Atherosclerosis Risk in Communities Study (ARIC) participants who in 2011-2013 had echocardiography and serum calcium and phosphorus measurements. We evaluated the association of serum calcium (corrected for albumin) and phosphorus quintiles with measures of LV structure and function, after adjusting for other cardiovascular risk factors. Participants were on average 75.3 years old; 59.1% were female and 19.8% were African American. Mean (±SD) concentrations of calcium and phosphorus were 9.33 ± 0.38 and 3.46 ± 0.45 mg/dL, respectively. Higher calcium was associated with lower LV end-diastolic diameter (LVEDD) but greater prevalence of concentric remodeling (p-trend: 0.005 and 0.004 respectively). We observed association between high phosphorus and high septal E/e' (p-trend: 0.02). Likewise, higher serum phosphorus was associated with higher left atrial volume index (p-trend: 0.001) and LV hypertrophy prevalence (p-trend: 0.04).

Conclusions: In conclusion, higher calcium was associated with more concentric remodeling but lower LVEDD, suggesting complex associations between calcium and cardiac function. Serum phosphorus was related to worse indices of LV diastolic function and LV hypertrophy, but not to LV systolic function. However, the magnitudes of association were modest, so clinical implications of these findings may be limited.

Keywords: Echocardiography; Left ventricular function; Left ventricular structure; Serum calcium; Serum phosphorus.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Biomarkers / blood
  • Calcium / blood*
  • Cross-Sectional Studies
  • Echocardiography, Doppler
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / blood
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / epidemiology*
  • Hypertrophy, Left Ventricular / physiopathology
  • Male
  • Phosphorus / blood*
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke Volume*
  • United States / epidemiology
  • Up-Regulation
  • Ventricular Dysfunction, Left / blood
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / epidemiology*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left*
  • Ventricular Remodeling*


  • Biomarkers
  • Phosphorus
  • Calcium