title: Coexistence of low vitamin D and high fibroblast growth factor-23 plasma levels predicts an adverse outcome in patients with coronary artery disease.
abstract: OBJECTIVE
  Vitamin D and fibroblast growth factor-23 (FGF-23) are related with cardiovascular disorders. We have investigated the relationship of calcidiol (vitamin D metabolite) and FGF-23 plasma levels with the incidence of adverse outcomes in patients with coronary artery disease.
  
  
  METHODS
  Prospective follow-up study of 704 outpatients, attending the departments of Cardiology of four hospitals in Spain, 6-12 months after an acute coronary event. Baseline calcidiol, FGF-23, parathormone, and phosphate plasma levels were assessed. The outcome was the development of acute ischemic events (any acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Cox regression adjusted for the main confounders was performed.
  
  
  RESULTS
  Calcidiol levels showed a moderate-severe decrease in 57.3% of cases. Parathormone, FGF-23, and phosphate levels were increased in 30.0%, 11.5% and 0.9% of patients, respectively. Only 22.4% of patients had glomerular filtration rate<60 ml/min1.73 m2. After a mean follow-up was 2.15±0.99 years, 77 patients developed the outcome. Calcidiol (hazard ratio [HR] = 0.67; 95% confidence interval [CI] = 0.48-0.94; p = 0.021) and FGF-23 (HR = 1.13; 95% CI = 1.04-1.23; p = 0.005) plasma levels predicted independently the outcome. There was a significant interaction between calcidiol and FGF-23 levels (p = 0.025). When the population was divided according to FGF-23 levels, calcidiol still predicted the outcome independently in patients with FGF-23 levels higher than the median (HR = 0.50; 95% CI = 0.31-0.80; p = 0.003) but not in those with FGF-23 levels below this value (HR = 1.03; 95% CI = 0.62-1.71; p = 0.904).
  
  
  CONCLUSIONS
  Abnormalities in mineral metabolism are frequent in patients with stable coronary artery disease. In this population, low calcidiol plasma levels predict an adverse prognosis in the presence of high FGF-23 levels.
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Tuñón
authors.affiliation: Department of Cardiology, Hospital de Fuenlabrada, Fuenlabrada, Spain; Rey Juan Carlos University, Alcorcón, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cristóbal
authors.affiliation: Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Tarín
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Aceña
authors.affiliation: Laboratory of Nephrology and Mineral Metabolism, Hospital Gómez-Ulla, Madrid, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: González-Casaus
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Huelmos
authors.affiliation: Department of Cardiology, Hospital de Fuenlabrada, Fuenlabrada, Spain; Rey Juan Carlos University, Alcorcón, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Lorenzo
authors.affiliation: Autónoma University, Madrid, Spain; Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: González-Parra
authors.affiliation: Department of Epidemiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahíllo-Fernández
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Pello
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Carda
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Farré
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.affiliation: Rey Juan Carlos University, Alcorcón, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: López-Bescós
authors.affiliation: Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain; Department of Nephrology, IIS-Fundación Jiménez Díaz, Madrid, Spain; CIBERDEM, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Egido
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014807:Vitamin D / Q000097:blood*
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
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