title: Serum phosphate is associated with aortic valve calcification in the Multi-ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  This study sought to investigate associations of phosphate metabolism biomarkers with aortic valve calcification (AVC).
  
  
  BACKGROUND
  Calcific aortic valve disease (CAVD) is a common progressive condition that involves inflammatory and calcification mediators. Currently there are no effective medical treatments, but mineral metabolism pathways may be important in the development and progression of disease.
  
  
  METHODS
  We examined associations of phosphate metabolism biomarkers, including serum phosphate, urine phosphate, parathyroid hormone (PTH) and serum fibroblast growth factor (FGF)-23, with CT-assessed AVC at study baseline and in short-term follow-up in 6814 participants of the Multi-Ethnic Study of Atherosclerosis (MESA).
  
  
  RESULTS
  At baseline, AVC prevalence was 13.2%. Higher serum phosphate levels were associated with significantly greater AVC prevalence (relative risk 1.3 per 1 mg/dL increment, 95% confidence incidence: 1.1 to 1.5, p<0.001). Serum FGF-23, serum PTH, and urine phosphate were not associated with prevalent AVC. Average follow-up CT evaluation was 2.4 years (range 0.9-4.9 years) with an AVC incidence of 4.1%. Overall, phosphate metabolism biomarkers were not associated with incident AVC except in the top FGF-23 quartile.
  
  
  CONCLUSIONS
  Serum phosphate levels are significantly associated with AVC prevalence. Further study of phosphate metabolism as a modifiable risk factor for AVC is warranted.
authors: Division of Cardiology, Emory University/Atlanta VA Medical Center, 1639 Pierce Drive, Suite 319, Atlanta, GA 30322, USA. Electronic address: jason.linefsky@emory.edu.
authors: Jason P
authors: JP
authors: Linefsky
authors: Division of Cardiology, University of Washington, Seattle, WA, USA.
authors: Kevin D
authors: KD
authors: O'Brien
authors: University of Washington Kidney Research Institute and Division of Nephrology, Seattle, WA, USA.
authors: Michael
authors: M
authors: Sachs
authors: Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors: Ronit
authors: R
authors: Katz
authors: Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: John
authors: J
authors: Eng
authors: Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
authors: Erin D
authors: ED
authors: Michos
authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA.
authors: Matthew J
authors: MJ
authors: Budoff
authors: University of Washington Kidney Research Institute and Division of Nephrology, Seattle, WA, USA.
authors: Ian
authors: I
authors: de Boer
authors: University of Washington Kidney Research Institute and Division of Nephrology, Seattle, WA, USA.
authors: Bryan
authors: B
authors: Kestenbaum
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000208:ethnology / Q000652:urine; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000208:ethnology / Q000652:urine; D005006:Ethnicity; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood* / Q000652:urine; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012959:Socioeconomic Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Aortic valve; Calcification; Phosphate