Highlights
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• In preserved renal function, FGF23 can turn up minute variations in phosphate.
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• Higher FGF23 levels associated independently with carotid atherosclerosis.
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• FGF23 might be a predictor of cardiovascular risk independent of renal failure.
Abstract
Background
Fibroblast growth factor 23 (FGF23) is a major determinant of mineral metabolism derangements
and emerges as a possible risk factor underlying the negative cardiovascular outcome
in CKD patients. However, its contribution in non-CKD individuals is less clear. This
cross-sectional study investigated the associations between FGF23 and mineral metabolism
parameters and with carotid atherosclerosis in a population at high cardiovascular
risk with preserved renal function.
Methods
We employed 939 subjects with coronary heart disease enrolled in the CORDIOPREV study
(mean eGFR=93.0 ± 0.7 ml/min/1.73 m2 and median FGF23=44.9 (IQR=13.1) pg/ml), in which intima-media thickness of both
common carotid arteries (IMT-CC) was measured.
Results
Adjusted for anthropometric factors, FGF23 associated positively with creatinine,
phosphate, calcium and 25(OH)-vitaminD and negatively with eGFR and calcitriol. In
multivariable-adjusted models all of them were independent contributors to FGF23 levels.
FGF23 showed a positive relationship with IMT-CC; both the higher third and fourth
quartiles associated significantly with IMT-CC (Beta= 0.135 and 0.187, respectively)
and after additional adjustment for established cardiovascular risk factors and morbidities
FGF23 remained as a significant contributor to IMT-CC. Logistic regression analysis
confirmed its predictive ability to differentiate patients at higher atherosclerotic
risk defined by an IMT-CC≥0.7 mm (OR for FGF23 quartiles 3 and 4 vs. 1: 1.860; 95%CI
1.209–2.862 and 2.114; 95%CI 1.339–3.337, respectively).
Conclusion
Even in the setting of a normally functioning phosphate-FGF23-calcitriol system, FGF23
independently associated with IMT-CC, a surrogate of atherosclerotic vascular dysfunction.
This supports the notion of FGF23 as a predictor of cardiovascular risk independent
of renal failure.
Keywords
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Article info
Publication history
Published online: December 30, 2019
Accepted:
December 17,
2019
Received in revised form:
December 15,
2019
Received:
July 31,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
