Research Group Cardiovascular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee, 114-116, 14558, Nuthetal, Germany,
Eur J Epidemiol. 2015 Feb;30(2):131-41. doi: 10.1007/s10654-014-9982-4. Epub 2014 Dec 21.
Increased fibroblast growth factor 23 (FGF23) concentrations have emerged as a novel risk factor for heart failure and stroke but not for myocardial infarction (MI). Yet, most studies on MI were conducted in coronary artery disease (CAD) patients and the elderly. Evidence is unclear in subjects without CAD and for stroke subtypes. We investigated the relationships between FGF23 and overall major cardiovascular endpoints, incident MI, ischemic (IS) and haemorrhagic stroke (HS) in middle-aged adults without pre-existing cardiovascular disease. We used a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition-Germany, including a randomly drawn subcohort (n = 1,978), incident MI (n = 463) and stroke cases (n = 359 IS; n = 88 HS) identified during a mean follow-up of 8.2 years. Compared with participants with FGF23 levels in the lowest quartile, those in the highest quartile had a 36% increased risk for cardiovascular events [hazard ratio: 1.36, 95% confidence interval (CI): 1.02-1.82] after adjustment for established cardiovascular risk factors, patahyroid hormone and 25-hydroxyvitamin D3 levels, dietary calcium and phosphorus intake, and kidney function. However, sub-analyses revealed significant relationships with risk of MI and HS, but not IS. Compared with the lowest quartile, individuals in the top two FGF23 quartiles had a 1.62 (95% CI 1.07-2.45) fold increased risk for MI and a 2.61 (95% CI 1.23-5.52) fold increase for HS. Increased FGF23 emerged as a risk factor for both MI and HS. Further studies are warranted to confirm these results and to identify underlying mechanisms.
成纤维细胞生长因子 23（FGF23）浓度升高已成为心力衰竭和中风的新危险因素，但不是心肌梗死（MI）的危险因素。然而，大多数关于 MI 的研究都是在冠状动脉疾病（CAD）患者和老年人中进行的。在没有 CAD 的受试者和中风亚型中，证据尚不清楚。我们研究了 FGF23 与无心血管疾病的中年成年人的主要心血管终点、MI、缺血性（IS）和出血性中风（HS）的关系。我们使用了嵌套在欧洲前瞻性癌症与营养研究-德国的病例-队列研究，包括一个随机抽取的亚队列（n=1978）、MI （n=463）和中风病例（n=359 IS；n=88 HS），平均随访 8.2 年后确定。与 FGF23 水平处于最低四分位的参与者相比，最高四分位的参与者发生心血管事件的风险增加了 36%[风险比：1.36，95%置信区间（CI）：1.02-1.82]，调整了已确立的心血管危险因素、甲状旁腺激素和 25-羟维生素 D3 水平、饮食钙和磷摄入量以及肾功能。然而，亚分析显示与 MI 和 HS 的风险存在显著关系，但与 IS 无显著关系。与最低四分位相比，FGF23 前两个四分位的个体患 MI 的风险增加了 1.62（95%CI 1.07-2.45），HS 的风险增加了 2.61（95%CI 1.23-5.52）。FGF23 升高是 MI 和 HS 的危险因素。需要进一步的研究来证实这些结果并确定潜在的机制。
