| Objective:Cardiovascular disease is a threat to human health. There are a great many risk factors that can cause cardiovascular disease, including uncontrolled and controlled factors. The controlled variables contain blood pressure, blood glucose, serum lipid levels and so on; while risk factors such as sex, gender and family history are uncontrolled variables.The major underlying factor leading to the occurrence and development of cardiovascular disease is atherosclerosis. Atherosclerosis develops slowly, however, the rupture of thrombogenic lipid-laden plaques leads to tissue hypoxia and necrosis and results in heart attack, stroke, or lower limb disease. CIMT is widely used as a surrogate marker for atherosclerosis and is regarded as a sensitive, reliable, convenient, and noninvasive method to assess the presence and extent of early atherosclerosis. Therefore, the severity of cardiovasular disease is often assessed by measurements of the CIMT. The development of cardiovascular disease is closely associated with the imbalance of serum trace elements and metabolic disturbance.Therefore, in the present study, we evaluated the relation of CIMT with serum levels of trace elements(zinc, copper, magnesium and calcium) in middle-aged and elderly physical examinees.Methods: This study was conducted in Health Examination Center of Hebei Province General Hospital from March to August, 2014. Written informed consent was obtained from all subjects. Eventually, a total of 1013 eligible individuals were enrolled in the study. CIMT was measured by ultrasound. Peripheral venous blood samples were collected from all participants after an 8-12 hours overnight fasting. Serum was obtained by centrifugation at 3,000 rpm for 10 min, processed immediately, placed in deionised polyethylene tubes, and stored at-80℃ until assayed. The serum levels of trace elements were determined by flame-atomic absorption spectrometer. Fasting plasma glucose(FPG), triglycerides(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), hepatic and kidney function were measured with an Hitachi7600 automatic analyzer. All statistical analyses were performed using SPSS 17.0 software.Results:1 The association of the baseline clinical characteristics and CIMTAmong the 1013 enrolled individuals, 704 were men and 309 were women. According to the level of CIMT, the participants were divided into normal CIMT group(CIMT≤0.9mm) and abnormal CIMT group(CIMT>0.9mm). We observed the differences of age, sex, glucose, lipid levels, hepatic and kidney function between the two group by Student t test, nonparametric test or chi-square test. Compared with the normal CIMT group, the abnormal CIMT group were older and had larger WC and BMI and higher level of blood pressure(P<0.05). The abnormal CIMT group also had higher levels of serum FBG, TC, TG, LDLC, APOB, Cr and BUN than the normal CIMT group(P<0.05). However there were no significant differences in AST, GGT, high-density lipoprotein, APOA1 and the proportions of current smokers and drinker between normal and abnormal groups.2 Associations between CIMT and serum levels of trace elementsWe observed the differences of serum levels of trace elementss(zinc, copper, magnesium and calcium) between normal and abnormal groups by nonparametric test. Compared with the normal CIMT group, the levels of zinc, and magnesium and were significantly lower in abnormal group(P<0.05), however, the levels of copper and calcium were significantly higher in abnormal group(P<0.05).3 The serum levels of trace elements according to the age groupWe divided the subjects into four groups according to each 10-year old increasing of age. The differences between group were compared using Kruscal-Wallis H and Mann-Whitney U analysis. The results showed that there were no significant differences in serum levels of Mg and Ca. However, the highest level of copper was especially observed in the subjects of group 60-69 years old with a median of 22.92 umol/L,but only had difference with group 50-59 years old(P=0.0013). While, the lowest level of zinc was especially observed in the subjects of group ≥70 years old with a median of 17.95 umol/L, but only had difference with group 50-59 years old(P=0.0001).4 The serum levels of trace elements according to the sexAmong the 1013 enrolled individuals, 704 were men and 309 were women. The differences between group were compared using nonparametric test analysis. The results showed that there were no significant differences in serum levels of zinc,calcium and magnesium, but only significant differences in serum level of copper.5 The association of serum zinc, copper, magnesium, and calcium level with related metabolic factorsIn the study, we detected the correlation of serum zinc, copper, magnesium, and calcium level with related metabolic factors by Spearman’s correlation coefficient. The results showed that serum zinc was negatively associated with age, SBP and BUN, but positively correlated with ALT, AST, TG and TC. However, serum copper level was negatively associated with Cr, while positively correlated with age, WC, BMI, SBP and FBG. The results showed that serum magnesium was positively correlated with WC, ALT, GGT, TG, and HDL-C, while serum calcium level was positively correlated with WC, ATL, AST, GGT, Uric, FBG, TG, TC and HDL-C.6 The association of serum zinc level with the prevalence of abnormal CIMTThe median concentration of serum zinc was 20.2umol/L in our study participants. We divided all the participants into four groups across zinc quartiles(Qzn1≤14.4umol/L, Qzn2:14.5-20.2umol/L, Qzn3:20.3-26.4umol/ L and Qzn4≥26.5umol/L). From the lowest quartile to the highest quartile of serum zinc level, the prevalence of abnormal CIMT were 66.7%, 55.1%, 45.1%, and 46.4%, respectively. Compared to subjects in first quartile, a significant decrease of prevalence of abnormal CIMT was observed in the second, third and highest quartiles(P=0.008, <0.001 and< 0.001, respectively). The results showed that compared with participants in quartile 1 of serum zinc, univariate logistic regression analysis showed that participants in quartile 2, quartile 3 and quartile 4 have a significant correlation with decreased odds of abnormal CIMT. After further adjustment for age, sex, BMI, smoking status, FPG, TG, TC, LDL-C, HDL-C, SBP, DBP, ALT, AST, Cr, Uric, BUN, serum copper, serum magnesium and serum calcium, the ORs of abnormal CIMT for increasing serum zinc quartiles were 1.00(reference), 0.49(95%CI 0.28-0.83), 0.15(95%CI 0.08-0.29) and 0.12(95%CI 0.06-0.23) respectively.7 The association of serum copper level with the prevalence of abnormal CIMTThe median concentration of serum copper was 21.9umol/L in our study participants. We divided all the participants into four groups across copper quartiles(Qcu1≤17.5umol/L, Qcu2: 17.6-21.9umol/L, Qcu3: 22.0-26.6umol/L and Qcu4≥26.7umol/L). From the lowest quartile to the highest quartile of serum copper level, the prevalence of abnormal CIMT were 41.7%, 45.3%, 61.2%, and 65.0%, respectively. Compared to subjects in highest quartile, a significant decrease of prevalence of abnormal CIMT was observed in the first and second quartiles(P < 0.001, and < 0.001, respectively). The results showed compared with participants in quartile 1 of serum copper, univariate logistic regression analysis showed that participants in quartile 2, quartile 3 and quartile 4 are significantly correlated with increased odds of abnormal CIMT. After further adjustment for age, sex, BMI, smoking status, FPG, TG, TC, LDL-C, HDL-C, SBP, DBP, ALT, AST, Cr, Uric, BUN, serum zinc, serum magnesium and serum calcium, the ORs of abnormal CIMT for increasing serum copper quartiles were 1.00(reference), 1.03(95%CI 0.87-1.79), 1.83(95%CI 0.91-3.69) and 2.34(95%CI 1.62-3.87) respectively.8 The association of serum magnesium level with the prevalence of abnormal CIMTThe median concentration of serum magnesium was 1.13mmol/L in our study participants. We divided all the participants into four groups across magnesium quartiles(Qmg1≤1.03mmol/L, Qmg2: 1.04-1.13mmol/L, Qmg3: 1.14-1.35mmol/L and Qmg4≥1.36mmol/L). From the lowest quartile to the highest quartile of serum magnesium level, the prevalence of abnormal CIMT were 45.6%, 63.4%, 42.3%, and 61.8%, respectively. Compared to subjects in highest quartile, a significant decrease of prevalence of abnormal CIMT was observed in the first and third quartiles(P< 0.001, and < 0.001, respectively). Compared with participants in quartile 1 of serum magnesium, univariate logistic regression analysis showed that participants in quartile 2 and quartile 4 are significant correlated with increased odds of having abnormal CIMT. After further adjustment for age, sex, BMI, smoking status, FPG, TG, TC, LDL-C, HDL-C, SBP, DBP, ALT, AST, Cr, Uric, BUN, serum copper, serum zinc and serum calcium, the ORs of abnormal CIMT for increasing serum magnesium quartiles were 1.00(reference), 1.36(95%CI 0.67-2.73), 0.20(95%CI 0.08-0.49) and 0.37(95%CI 0.11-1.21) respectively.9 The association of serum calcium level with the prevalence of abnormal CIMTThe median concentration of serum calcium was 2.90mmol/L in our study participants. We divided all the participants into four groups across calcium quartiles(Qca1≤2.62mmol/L, Qca2: 2.63-2.90mmol/L, Qca3: 2.91-3.57mmol/L and Qca4≥3.58mmol/L). From the lowest quartile to the highest quartile of serum calcium level, the prevalence of abnormal CIMT were 43.3%, 52.3%, 50.6%, and 67.0%, respectively. Compared to subjects in highest quartile, a significant decrease of prevalence of abnormal CIMT was observed in the first, second and third quartiles(P < 0.001,= 0.001, and < 0.001, respectively). The results showed that compared with participants in quartile 1 of serum calcium, univariate logistic regression analysis showed that participants in quartile 2, quartile 3 and quartile 4 are significantly correlated with increased odds of abnormal CIMT. After further adjustment for age, sex, BMI, smoking status, FPG, TG, TC, LDL-C, HDL-C, SBP, DBP, ALT, AST, Cr, Uric, BUN, serum copper, serum zinc and serum magnesium, the ORs of abnormal CIMT for increasing serum calcium quartiles were 1.00(reference), 1.35(95%CI 0.73-2.46), 1.16(95%CI 0.48-2.75) and 2.10(95%CI 1.46-3.47) respectively.10 The correlation of CIMT with related metabolic factorsCIMT was treated as an independent factor. We detected the correlation of CIMT with serum levels of trace elementss(zinc, copper, magnesium and calcium), age, sex, WC, BMI, blood pressure, smoking, alcoholic drinking, lipid, glucose, hepatic and kidney function by multivariable logistic regression. The results indicated that there was a negative association between CIMT and serum zinc and magnesium, and a positive association between CIMT and age, LDL-C,serum copper and serum calcium.Conclusion:1 Compared with the normal CIMT group, the levels of zinc and magnesium were significantly lower in abnormal group and there was a significant negative correlation between CIMT and serum levels of zinc and magnesium.2 The levels of copper and calcium were significantly higher in abnormal group and there was a significant positive correlation between CIMT and the serum levels of copper and calcium. |
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