Serum Calcium and Phosphate level and Carotid Atherosclerotic Plaque Characteristics: a retrospective study by High-Resolution MR Vessel Wall Imaging

Xiaowei Song^1*Hongliang Zhao¹Zhuoma Pengmao¹Duoduo Hou¹Xihai Zhao^1,2Zhuozhao Zheng¹Jian Wu^1,3*

• ¹Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
• ²Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, Beijing Municipality, China
• ³IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, Beijing, Beijing, China

Background and Aims: Serum calcium (Ca), phosphate (P), and calcium-phosphate product (CPP) are associated with cardiovascular disease and atherosclerosis in patients with chronic kidney disease. However, it remains unclear whether this relationship persists in individuals with carotid artery atherosclerosis of acute ischemic stroke. We investigated the association between serum Ca, P, as well as CPP and carotid artery atherosclerotic plaque in acute ischemic stroke patients.A total of 251 ischemic stroke participants with carotid artery atherosclerosis (mean age: 68 years; male: 80.1%) were retrospectively enrolled at a comprehensive stroke center. Serum Ca and P levels were obtained from blood tests after admission. Carotid artery plaque burden and vulnerability were evaluated using high-resolution magnetic resonance vessel wall imaging. Subsequently, the associations between serum Ca, P, as well as CPP and the characteristics of atherosclerotic plaques were analyzed using multivariate linear and logistic regression analyses. Finally, the consistency of these associations was also explored across different subgroups. As a result, Serum P and CPP were associated with carotid artery plaque burden, presented as maximum wall thickness (max WT), wall area, and lipid-rich necrotic core (LRNC), in univariate analysis, with β=-0.205，95% CI (-0.348,-0.061), β=-0.258，95% CI (-0.405,-0.113), OR=0.182, 95% CI (0.034,0.975) for P, and β=-0.203，95% CI (-0.346,-0.059), β=-0.221，95% CI (-0.366,-0.074), OR=0.466, 95% CI (0.237,0.915) for CPP, respectively. In multivariate regression analysis, the serum P level was independently associated with wall area, β=-0.211, 95% CI (-0.367, -0.052).Lower serum phosphorus level is associated with an increased carotid artery plaque wall area.