Phosphate, Calcification in Blood, and Mineral Stress: The Physiologic Blood Mineral Buffering System and Its Association with Cardiovascular Risk

Figure 1

Schematic illustration of the Mineral Stress hypothesis. Mineral Stress is caused by excess calciprotein particles, which upon interaction with susceptible cells, tissues, and organs induce damage in the form of oxidative stress, inflammation, and calcification. These clinical problems then contribute to adverse outcome. CPP are formed by the blood mineral buffering system when calcium and phosphate concentrations are raised. Primary CPP (CPP1) occur earlier during excess mineral buffering, whereas CPP2 should not occur in sizeable amounts, because CPP in general are rapidly cleared from circulation. Longer crystal formation time in vitro has consistently been associated with better cardiovascular outcome in multiple clinical studies. Figure provided with courtesy from Calciscon AG.