Fibroblast growth factor-23 and death, heart failure, and cardiovascular events in community-living individuals
JACC Cardiovascular Interventions, 07/11/2012
Ix JH et al. – FGF–23, a hormone involved in phosphorous and vitamin D homeostasis, is independently associated with all–cause death and incident heart failure (HF) in community–living older persons. These associations appear stronger in persons with cardiovascular disease (CVD).Methods
- Plasma FGF–23 was measured in 3,107 community–living persons ≥65 years of age in 1996 and 1997, and participants were followed through 2008.
- HF and CVD events were adjudicated by a panel of experts.
- Associations of FGF–23 with each outcome were evaluated using Cox proportional hazards models, and authors tested whether associations differed by CKD status.
- Both lower estimated glomerular filtration rate and higher urine albumin to creatinine ratios were associated with high FGF–23 at baseline.
- During 10.5 years (median) follow–up, there were 1,730 deaths, 697 incident HF events, and 797 incident CVD events.
- Although high FGF–23 concentrations were associated with each outcome in combined analyses, the associations were consistently stronger for those with CKD (p interactions all <0.006).
- In the CKD group (n = 1,128), the highest FGF–23 quartile had adjusted hazards ratios (HR) of 1.87 (95% confidence interval [CI]: 1.47 to 2.38) for all–cause death, 1.94 (95% CI: 1.32 to 2.83) for incident HF, and 1.49 (95% CI: 1.02 to 2.18) for incident CVD events compared with the lowest quartile.
- Corresponding HRs in those without CKD (n = 1,979) were 1.29 (95% CI: 1.05 to 1.59), 1.37 (95% CI: 0.99 to 1.89), and 1.07 (95% CI: 0.79 to 1.45).