From the Kidney Research Institute, Department of Medicine, Division of Nephrology (B.K., M.C.S., C.R.-C., J.R., D.R., I.H.d.B.), Department of Laboratory Medicine (A.N.H.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (D.S.S.), and Department of Epidemiology (M.B.), University of Washington, Seattle; Division of Nephrology, Department of Medicine, University of California at San Diego (J.H.I.); Nephrology Section, Veterans Affairs San Diego Healthcare System, CA (J.H.I.); and Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California at San Diego (J.H.I.); Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.C.L.); and Department of Radiology, Tufts-New England Medical Center, Boston, MA (J.F.P.).
Circ Heart Fail. 2014 May;7(3):409-17. doi: 10.1161/CIRCHEARTFAILURE.113.000952. Epub 2014 Mar 25.
Fibroblast growth factor-23 (FGF-23) is a phosphate regulatory hormone that directly stimulates left ventricular hypertrophy in experimental models. The role of FGF-23 in cardiovascular disease development in the general population is unclear. We tested associations of FGF-23 with major subclinical and clinical cardiovascular disease outcomes in a large prospective cohort.
We evaluated 6547 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who were initially free of cardiovascular disease. We measured serum FGF-23 using the Kainos immunoassay. The MESA measured left ventricular mass by MRI, coronary calcium by computed tomography, and carotid intima-media thickness by ultrasound. The MESA adjudicated incident heart failure, coronary heart disease, and stroke by medical record review. After adjustment, the highest FGF-23 quartile was associated with an estimated 2.4-g greater left ventricular mass (95% confidence interval, 0.4-4.5 greater) and a 26% greater odds of higher coronary calcium scores (95% confidence interval, 9%-46% greater) compared with the lowest quartile. During 7.5-year follow-up, each 20-pg/mL higher FGF-23 concentration was associated with a 19% greater risk of heart failure (95% confidence interval, 3%-37% greater) and a 14% greater risk of coronary heart disease (95% confidence interval, 1%-28% greater). FGF-23 was not associated with carotid intima-media thickness or stroke.
Higher serum FGF-23 concentrations are associated with subclinical cardiac disease and with new heart failure and coronary disease events, but not with carotid intima-media thickness or stroke. FGF-23 may be a novel cardiovascular risk factor in the general population.
成纤维细胞生长因子 23（FGF-23）是一种磷调节激素，它可直接刺激实验模型中的左心室肥大。FGF-23 在普通人群中心血管疾病发展中的作用尚不清楚。我们在一个大型前瞻性队列中检测了 FGF-23 与主要亚临床和临床心血管疾病结局之间的关联。
我们评估了最初无心血管疾病的动脉粥样硬化多民族研究（MESA）中的 6547 名参与者。我们使用 Kainos 免疫测定法测量血清 FGF-23。MESA 通过 MRI 测量左心室质量，通过计算机断层扫描测量冠状动脉钙，通过超声测量颈动脉内膜中层厚度。MESA 通过病历审查判定心力衰竭、冠心病和中风的发生情况。调整后，与最低四分位数相比，最高四分位数的 FGF-23 与估计的左心室质量增加 2.4g（95%置信区间，0.4-4.5 更大）和冠状动脉钙评分增加 26%（95%置信区间，9%-46% 更大）相关。在 7.5 年的随访期间，FGF-23 每增加 20pg/ml，心力衰竭的风险增加 19%（95%置信区间，3%-37% 更大），冠心病的风险增加 14%（95%置信区间，1%-28% 更大）。FGF-23 与颈动脉内膜中层厚度或中风无关。
较高的血清 FGF-23 浓度与亚临床心脏疾病以及新发心力衰竭和冠心病事件相关，但与颈动脉内膜中层厚度或中风无关。FGF-23 可能是普通人群中的一种新的心血管危险因素。
