成纤维细胞生长因子 23 和非羧化基质 Gla 蛋白与冠心病死亡率的关系：心脏与灵魂研究。
The associations of fibroblast growth factor 23 and uncarboxylated matrix Gla protein with mortality in coronary artery disease: the Heart and Soul Study.
机构信息
Division of Nephrologyand Hypertension, Department of Medicine, University of California-San Diego, CA 92161, USA.
出版信息
Ann Intern Med. 2010 May 18;152(10):640-8. doi: 10.7326/0003-4819-152-10-201005180-00004.
BACKGROUND
Fibroblast growth factor 23 (FGF23), uncarboxylated matrix Gla protein (ucMGP), and fetuin-A are regulators of mineral metabolism and inhibitors of vascular calcification. Whether circulating levels of each are associated with cardiovascular disease (CVD) events or mortality in populations without end-stage renal disease is unknown.
OBJECTIVE
To evaluate the associations of FGF23, ucMGP, and fetuin-A with mortality and CVD events.
DESIGN
Observational study.
SETTING
12 outpatient clinics in the San Francisco Bay area.
PATIENTS
833 outpatients with stable coronary artery disease (CAD), recruited from 11 September 2000 to 20 December 2002.
MEASUREMENTS
Fibroblast growth factor 23, ucMGP, and fetuin-A concentrations were measured at baseline. Participants were followed until 1 December 2008 for mortality and CVD events.
RESULTS
During a median follow-up of 6.0 years, 220 participants died and 182 had CVD events. Compared with participants with FGF-23 levels in the lowest tertile, those in the highest tertile had 2-fold greater risk for mortality (hazard ratio [HR], 2.15 [95% CI, 1.43 to 3.24]) and CVD events (HR, 1.83 [CI, 1.15 to 2.91]) after adjustment for traditional CVD risk factors, C-reactive protein levels, and kidney function. The highest ucMGP tertile was associated with lower mortality risk (HR, 0.48 [CI, 0.31 to 0.75]) and showed a nonsignificant trend toward lower CVD event risk by tertile analysis (HR, 0.65 [CI, 0.40 to 1.05])-an association that was significant when modeled continuously (P = 0.029). No significant association of fetuin-A with mortality (HR, 0.84 [CI, 0.55 to 1.27]) or CVD events (HR, 0.99 [CI, 0.64 to 1.55]) was observed.
LIMITATION
Participants had prevalent CAD.
CONCLUSION
In outpatients with stable CAD, higher FGF23 and lower ucMGP levels are independently associated with mortality and CVD events.
PRIMARY FUNDING SOURCE
American Heart Association.
背景
成纤维细胞生长因子 23（FGF23）、非羧化基质 Gla 蛋白（ucMGP）和胎球蛋白-A 是矿物质代谢的调节剂和血管钙化的抑制剂。在没有终末期肾病的人群中，循环水平的这些物质是否与心血管疾病（CVD）事件或死亡率相关尚不清楚。
目的
评估 FGF23、ucMGP 和胎球蛋白-A 与死亡率和 CVD 事件的相关性。
设计
观察性研究。
地点
旧金山湾区的 12 个门诊诊所。
患者
2000 年 9 月 11 日至 2002 年 12 月 20 日招募的 833 名稳定型冠状动脉疾病（CAD）门诊患者。
测量
基线时测量 FGF23、ucMGP 和胎球蛋白-A 浓度。参与者随访至 2008 年 12 月 1 日，以记录死亡率和 CVD 事件。
结果
中位随访 6.0 年期间，220 名参与者死亡，182 名发生 CVD 事件。与 FGF-23 水平处于最低三分位的参与者相比，处于最高三分位的参与者死亡风险增加 2 倍（风险比 [HR]，2.15 [95%CI，1.43 至 3.24]）和 CVD 事件（HR，1.83 [CI，1.15 至 2.91]），调整传统 CVD 危险因素、C 反应蛋白水平和肾功能后。最高的 ucMGP 三分位数与较低的死亡率风险相关（HR，0.48 [CI，0.31 至 0.75]），且按三分位数分析呈 CVD 事件风险降低的趋势（HR，0.65 [CI，0.40 至 1.05]）-这种关联在连续模型中具有统计学意义（P = 0.029）。未观察到胎球蛋白-A 与死亡率（HR，0.84 [CI，0.55 至 1.27]）或 CVD 事件（HR，0.99 [CI，0.64 至 1.55]）显著相关。
局限性
参与者患有现患 CAD。
结论
在稳定型 CAD 的门诊患者中，较高的 FGF23 和较低的 ucMGP 水平与死亡率和 CVD 事件独立相关。
主要资金来源
美国心脏协会。
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