title: Fibroblast Growth Factor 23 and Cause-Specific Mortality in the General Population: The Northern Manhattan Study.
abstract: An elevated fibroblast growth factor (FGF) 23 is an independent risk factor for cardiovascular disease and mortality in patients with kidney disease. The relationship between FGF23 and cause-specific mortality in the general population is unknown.
  
  
  
  To investigate the association of elevated FGF23 with the risk of cause-specific mortality in a racially and ethnically diverse urban general population.
  
  
  
  The Northern Manhattan Study is a population-based prospective cohort study. Residents who were > 39 years old and had no history of stroke were enrolled between 1993 and 2001. Participants with available blood samples for baseline FGF23 testing were included in the current study (n = 2525).
  
  
  
  Cause-specific death events.
  
  
  
  A total of 1198 deaths (474 vascular, 612 nonvascular, 112 unknown cause) occurred during a median follow-up of 14 years. Compared to participants in the lowest FGF23 quintile, those in the highest quintile had a 2.07-fold higher risk (95% confidence interval [CI], 1.45, 2.94) of vascular death and a 1.64-fold higher risk (95% CI, 1.22, 2.20) of nonvascular death in fully adjusted models. Higher FGF23 was independently associated with increased risk of mortality due to cancer, but only in Hispanic participants (hazard ratio per 1 unit increase in ln FGF23 of 1.87; 95% CI, 1.40, 2.50; P for interaction = .01).
  
  
  
  Elevated FGF23 was independently associated with increased risk of vascular and nonvascular mortality in a diverse general population and with increased risk of cancer death specifically in Hispanic individuals.
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Nao
authors: N
authors: Souma
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Tamara
authors: T
authors: Isakova
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: David
authors: D
authors: Lipiszko
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Ralph L
authors: RL
authors: Sacco
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Mitchell S V
authors: MS
authors: Elkind
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Janet T
authors: JT
authors: DeRosa
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Shonni J
authors: SJ
authors: Silverberg
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Armando J
authors: AJ
authors: Mendez
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Chuanhui
authors: C
authors: Dong
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Clinton B
authors: CB
authors: Wright
authors: Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine (N.S., T.I., D.L., M.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; Evelyn F. McKnight Brain Institute (R.L.S., C.D., C.B.W.) and Departments of Neurology (R.L.S., C.B.W.), Public Health Sciences (R.L.S., C.B.W.), Human Genomics (R.L.S.), Medicine (A.J.M.), and the Neuroscience Program (R.L.S., C.B.W.), Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 33136; and Departments of Neurology (M.S.V.E., J.T.D.) and Medicine (S.J.S.), College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, New York 10032.
authors: Myles
authors: M
authors: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology; D002423:Cause of Death; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000208:ethnology / Q000401:mortality; D009519:New York City / Q000208:ethnology; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014652:Vascular Diseases / Q000097:blood / Q000208:ethnology / Q000401:mortality; D044465:White People / Q000208:ethnology; D001741:Black or African American
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23