title: Serum FGF23 and risk of cardiovascular events in relation to mineral metabolism and cardiovascular pathology.
abstract: OBJECTIVE
  Circulating fibroblast growth factor-23 is associated with adverse cardiovascular outcomes in CKD and non-CKD individuals, but the underlying mechanism remains unclear. This study tested whether this association is independent of mineral metabolism and indices of subclinical cardiovascular pathology.
  
  
  METHODS
  The prospective association between fibroblast growth factor-23 and major cardiovascular events (a composite of hospital-treated myocardial infarction, hospital-treated stroke, or all-cause mortality) was investigated in the community-based Prospective Investigation of the Vasculature in Uppsala Seniors (n=973; mean age=70 years, 50% women) using multivariate logistic regression. Subjects were recruited between January of 2001 and June of 2004.
  
  
  RESULTS
  During follow-up (median=5.1 years), 112 participants suffered a major cardiovascular event. In logistic regression models adjusted for age, sex, and estimated GFR, higher fibroblast growth factor-23 was associated with increased risk for major cardiovascular events (odds ratio for tertiles 2 and 3 versus tertile 1=1.92, 95% confidence interval=1.19-3.09, P<0.01). After additional adjustments in the model, adding established cardiovascular risk factors, confounders of mineral metabolism (calcium, phosphate, parathyroid hormone, and 25(OH)-vitamin D), and indices of subclinical pathology (flow-mediated vasodilation, endothelial-dependent and -independent vasodilation, arterial stiffness, and atherosclerosis and left ventricular mass) attenuated this relationship, but it remained significant (odds ratio for tertiles 2 and 3 versus tertile 1=1.69, 95% confidence interval=1.01-2.82, P<0.05).
  
  
  CONCLUSIONS
  Fibroblast growth factor-23 is an independent predictor of cardiovascular events in the community, even after accounting for mineral metabolism abnormalities and subclinical cardiovascular damage. Circulating fibroblast growth factor-23 may reflect novel and important aspects of cardiovascular risk yet to be unraveled.
authors: Department of Public Health and Caring Sciences/Section of Geriatrics, Uppsala University, Uppsala, Sweden.
authors: Johan
authors: J
authors: Ärnlöv
authors: Axel C
authors: AC
authors: Carlsson
authors: Johan
authors: J
authors: Sundström
authors: Erik
authors: E
authors: Ingelsson
authors: Anders
authors: A
authors: Larsson
authors: Lars
authors: L
authors: Lind
authors: Tobias E
authors: TE
authors: Larsson
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling; D002118:Calcium / Q000097:blood; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005919:Glomerular Filtration Rate; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013548:Sweden; D013997:Time Factors; D016277:Ventricular Function, Left; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; C104450:25-hydroxyvitamin D; D002118:Calcium