Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
Lazio Regional Health Service, Rome, Italy.
J Intern Med. 2015 Mar;277(3):318-330. doi: 10.1111/joim.12232. Epub 2014 Mar 29.
Fibroblast growth factor-23 (FGF-23) and vitamin D are hormones involved in phosphate homoeostasis. They also directly influence cardiomyocyte hypertrophy. We examined whether the relationships between levels of vitamin D or FGF-23, cardiac phenotype and outcome were independent of established cardiac biomarkers in a large cohort of community-dwelling elderly subjects.
Plasma levels of FGF-23 and vitamin D were measured in 1851 men and women (65-84 years) resident in the Lazio region of Italy. Participants were referred to eight cardiology centres for clinical examination, electrocardiography, comprehensive Doppler echocardiography and blood sampling. All-cause mortality or hospitalizations were available after a median follow-up of 47 months with record linkage of administrative data.
Vitamin D deficiency (<20 ng mL(-1) ) was found in 72.3% of subjects, but FGF-23 levels were normal [74 (58-97) RU per mL]. After adjustment for cardiovascular risk factors and morbidities, low concentrations of vitamin D and high levels of FGF-23 were associated with a higher left ventricular (LV) mass index. Levels of FGF-23 [hazard ratio (HR) (95% confidence interval (CI)) 1.71 (1.28-2.28), P < 0.0001] but not vitamin D [0.76 (0.57-1.01), P = 0.08] were independently associated with mortality after adjustment for clinical risk factors and two cardiac markers together (N-terminal pro-brain natriuretic peptide and high-sensitivity cardiac troponin T), but did not predict hospital admission. People with above median values of FGF-23 and below median values of vitamin D had greater LV hypertrophy and higher mortality.
In community-dwelling elderly individuals with highly prevalent vitamin D deficiency, FGF-23 levels were associated with LV hypertrophy and predicted mortality independently of two robust cardiac biomarkers. A causal relationship was not demonstrated, but the hormones involved in mineral metabolism emerged as nontraditional risk factors and may affect cardiovascular risk.
成纤维细胞生长因子 23（FGF-23）和维生素 D 是参与磷稳态的激素。它们还直接影响心肌细胞肥大。我们在一个大型社区居住的老年人群中检查了维生素 D 或 FGF-23 的水平与心脏表型和结局之间的关系是否独立于既定的心脏生物标志物。
在意大利拉齐奥地区的 1851 名 65-84 岁的男性和女性中测量了 FGF-23 和维生素 D 的血浆水平。参与者因临床检查、心电图、全面多普勒超声心动图和血液采样而被转诊至 8 个心脏病中心。中位随访 47 个月后，通过行政数据的记录链接，获得了全因死亡率或住院率。
维生素 D 缺乏症（<20ng/mL）在 72.3%的受试者中发现，但 FGF-23 水平正常[74（58-97）RU/mL]。调整心血管危险因素和合并症后，维生素 D 浓度低和 FGF-23 水平高与左心室（LV）质量指数较高相关。FGF-23 水平[风险比（HR）（95%置信区间（CI））1.71（1.28-2.28），P<0.0001]但不是维生素 D [0.76（0.57-1.01），P=0.08]与调整临床危险因素和两种心脏标志物（N-端脑利钠肽前体和高敏心肌肌钙蛋白 T）后死亡率独立相关，但不预测住院。FGF-23 中位数以上和维生素 D 中位数以下的人 LV 肥大更大，死亡率更高。
在维生素 D 缺乏症患病率极高的社区居住的老年人群中，FGF-23 水平与 LV 肥大相关，并独立于两种可靠的心脏生物标志物预测死亡率。未证明因果关系，但参与矿物质代谢的激素作为非传统危险因素出现，可能影响心血管风险。
