title: Circulating fibroblast growth factor-23 plasma levels predict adverse cardiovascular outcomes in patients with diabetes mellitus with coronary artery disease.
abstract: Abnormalities of fibroblast growth factor-23 (FGF-23) plasma levels predict adverse outcomes in patients with coronary artery disease. However, FGF-23 has a different behaviour in the presence of type 2 diabetes mellitus (T2D). We explored whether the presence of T2D affects the predictive power of FGF-23.
  
  
  
  In 704 patients with stable coronary artery disease, FGF-23, calcidiol, parathormone (PTH) and phosphate plasma levels were prospectively assessed. The primary outcome was the development of acute ischemic events (acute coronary syndrome, stroke or transient ischemic attack), heart failure or death.
  
  
  
  One hundred seventy-three (24.6%) patients had T2D, without differences in age, sex or estimated glomerular filtration rate as compared with non-diabetic patients. Serum PTH was lower and phosphate higher in T2D than in non-diabetic patients, without differences in FGF-23 or calcidiol levels. During follow-up (2.15 ± 0.99 years), 26 (15.2%) T2D and 51 (9.6%) non-diabetic patients developed the outcome (p = 0.048). T2D patients who developed the outcome had higher FGF-23 [112.0 (59.9, 167.6) vs 68.9 (54.2, 93.0) RU/mL; p = 0.002], PTH [71.3 (47.3, 106.6) vs 51.9 (40.8, 66.2) pg/mL; p = 0.004) and phosphate (3.53 ± 0.71 vs 3.25 ± 0.50 mg/dL; p = 0.017) levels than T2D subjects who remained stable. These differences were not significant in non-diabetic patients. By multivariable Cox proportional hazard model, FGF-23 predicted independently the outcome in T2D patients [hazard ratio = 1.277; 95% CI (1.132, 1.442)] but not in those without T2D.
  
  
  
  FGF-23 plasma levels predict adverse cardiovascular outcomes in coronary artery disease patients who have T2D but not in those without T2D. This finding should be confirmed in larger studies. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain. jtunon@secardiologia.es.|Autónoma University, Madrid, Spain. jtunon@secardiologia.es.
authors.forename: José
authors.initials: J
authors.lastname: Tuñón
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Fernández-Fernández
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Carda
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Pello
authors.affiliation: Hospital de Fuenlabrada, Fuenlabrada, Spain.|Rey Juan Carlos University, Alcorcón, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cristóbal
authors.affiliation: University Hospital of Móstoles, Móstoles, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Tarín
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Aceña
authors.affiliation: Hospital Gómez-Ulla, Madrid, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: González-Casaus
authors.affiliation: University Hospital Fundación Alcorcón, Alcorcón, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Huelmos
authors.affiliation: Rey Juan Carlos University, Alcorcón, Spain.|University Hospital of Getafe, Getafe, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Alonso
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.|Autónoma University, Madrid, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Lorenzo
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.|Autónoma University, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: González-Parra
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Hernández-González
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahíllo-Fernández
authors.affiliation: Rey Juan Carlos University, Alcorcón, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: López-Bescós
authors.affiliation: IIS-Fundación Jiménez Díaz, Madrid, Spain.|Autónoma University, Madrid, Spain.|CIBERDEM, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Egido
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002112:Calcifediol / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000473:pathology; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002112:Calcifediol
keywords: coronary artery disease; diabetes mellitus; fibroblast growth factor-23; mineral metabolism; vitamin D