Fibroblast Growth Factor‐23 and Incident Coronary Heart Disease, Heart Failure, and Cardiovascular Mortality: The Atherosclerosis Risk In Communities Study

Journal of the American Heart Association - Tập 3 Số 3 - 2014
Pamela L. Lutsey1, Álvaro Alonso2, Elizabeth Selvin3, James S. Pankow4, Erin D. Michos5, Sunil Agarwal6, Laura R. Loehr7, John H. Eckfeldt8, Josef Coresh9
1Pamela L. Lutsey Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
2Alvaro Alonso Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
3Elizabeth Selvin Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD
4James S. Pankow Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
5Erin D. Michos Division of Cardiology, Johns Hopkins University, Baltimore, MD
6Sunil K. Agarwal Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD
7Laura R. Loehr Department of Epidemiology, University of North Carolina, Chapel Hill, NC
8John H. Eckfeldt Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
9Josef Coresh Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD

Tóm tắt

Background Fibroblast growth factor‐23 ( FGF ‐23) is a hormone involved in phosphorous regulation and vitamin D metabolism that may be associated with cardiovascular risk, and it is a potential target for intervention. We tested whether elevated FGF ‐23 is associated with incident coronary heart disease, heart failure, and cardiovascular mortality, even at normal kidney function.

Methods and Results A total of 11 638 Atherosclerosis Risk In Communities study participants, median age 57 at baseline (1990–1992), were followed through 2010. Cox regression was used to evaluate the independent association of baseline serum active FGF‐23 with incident outcomes. Models were adjusted for traditional cardiovascular risk factors and estimated glomerular filtration rate. During a median follow‐up of 18.6 years, 1125 participants developed coronary heart disease, 1515 developed heart failure, and 802 died of cardiovascular causes. For all 3 outcomes, there was a threshold, whereby FGF‐23 was not associated with risk at <40 pg/mL but was positively associated with risk at >40 pg/mL. Compared with those with FGF‐23 <40 pg/mL, those in the highest FGF‐23 category (≥58.8 pg/mL) had a higher risk of incident coronary heart disease (adjusted hazard ratio, 95% CIs: 1.65, 1.40 to 1.94), heart failure (1.75, 1.52 to 2.01), and cardiovascular mortality (1.65, 1.36 to 2.01). Associations were modestly attenuated but remained statistically significant after further adjustment for estimated glomerular filtration rate. In stratified analyses, similar results were observed in African Americans and among persons with normal kidney function.

Conclusions High levels of serum FGF ‐23 were associated with increased risk of coronary heart disease, heart failure, and cardiovascular mortality in this large, biracial, population‐based cohort. This association was independent of traditional cardiovascular risk factors and kidney function.

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Journal of the American Heart Association

Tập 3 Số 3

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