title: Relations of serum phosphorus levels to echocardiographic left ventricular mass and incidence of heart failure in the community.
abstract: OBJECTIVE
  To evaluate the association of serum phosphorus with cardiac structure/function and incident heart failure.
  
  
  RESULTS
  We related serum phosphorus to echocardiographic left ventricular (LV) measurements cross-sectionally, and to incident heart failure prospectively in 3300 participants (mean age 44 years, 51% women) free of heart failure, myocardial infarction, and chronic kidney disease (estimated glomerular filtration rate [eGFR]<60 mL/min/1.73 m(2)). Cross-sectionally, serum phosphorus was related positively to LV mass, internal dimensions, and systolic dysfunction. On follow-up (mean 17.4 years), 157 individuals developed heart failure. In models adjusting for established risk factors as time-varying covariates, each mg/dL increment in serum phosphorus was associated with a 1.74-fold risk of heart failure [95% confidence intervals (CI) 1.17-2.59]. Individuals in the highest serum phosphorus quartile experienced a two-fold (95% CI 1.28-3.40) risk of heart failure compared with participants in the lowest quartile. These relations were maintained upon additional adjustment for LV mass/dimensions and systolic dysfunction. In analyses restricted to individuals with eGFR >90 mL/min/1.73 m(2), no proteinuria and serum phosphorus <4.5 mg/dL, the association of serum phosphorus with heart failure remained robust.
  
  
  CONCLUSIONS
  In our community-based sample, higher serum phosphorus was associated with greater LV mass cross-sectionally, and with an increased risk of heart failure prospectively.
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Dhingra
authors.forename: Philimon
authors.initials: P
authors.lastname: Gona
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.forename: Jayashri
authors.initials: J
authors.lastname: Aragam
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: William B
authors.initials: WB
authors.lastname: Kannel
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D003198:Computer Simulation; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010758:Phosphorus / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D014481:United States / Q000453:epidemiology
chemical_list: D010758:Phosphorus