Division of Cardiovascular Diseases and Hypertension, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ.
Center for Translational Metabolism and Health, Department of Preventive Medicine and Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Am Heart J. 2022 Mar;245:10-18. doi: 10.1016/j.ahj.2021.11.009. Epub 2021 Nov 30.
Elevated Fibroblast Growth Factor-23 (FGF23) levels have been associated with greater left ventricular mass (LVM) and heart failure. Whether higher FGF23 is associated with higher LVH prevalence and longitudinal changes in LVM and myocardial strain in middle-aged adults without cardiovascular disease (CVD) or chronic kidney disease (CKD) is unknown.
We studied 3,113 adults without CVD at baseline participating in the Year 25 (2010-2011) follow-up exam of the Coronary Artery Risk Development in Young Adults (CARDIA) study. We studied the association of Year 25 c-terminal FGF23 concentrations with indexed LVM (LVMI=LVM/height), LVH and myocardial strain as assessed by speckle tracking strain echocardiography. Among the 2,758 (88.6%) participants who returned for the Year 30 examination, we also investigated the association of Year 25 FGF23 with 5 Year change in LVMI, strain parameters and incident LVH.
The mean age was 50.0 (±3.6) years, 56.8% were female, 45.7% were Black and 6.4% had CKD. There was 6.0% LVH prevalence at Year 25. Mean 5 Year change in LVMI was 5.3 (±7.7) grams/meter. In multivariable models, FGF23 in the highest quartile was associated with greater odds of LVH at Year 25 compared to lower quartiles. [Odds Ratio 95% CI: 1.81 (1.28, 2.58)] with similar findings after exclusion of participants with CKD. There was no interaction between FGF23 and race (P = .18) or sex (P = .80). There was no association between FGF23 and global longitudinal strain. There was no association between FGF23 and 5 Year change in LVMI. There was no association between higher FGF23 and 5 year incident LVH.
In a middle-aged adult population without known CVD or CKD, higher FGF23 was associated with greater odds of LVH, but not with greater increases in LVM over time. Further study is needed to elucidate whether FGF23 is a risk marker for underlying LVH or a mechanism for increased LVM over time in younger and middle-aged adult populations without CKD.
成纤维细胞生长因子 23（FGF23）水平升高与左心室质量（LVM）增加和心力衰竭有关。在没有心血管疾病（CVD）或慢性肾脏病（CKD）的中年成年人中，较高的 FGF23 是否与更高的 LVH 患病率以及 LVM 和心肌应变的纵向变化有关尚不清楚。
我们研究了基线时无 CVD 的 3113 名成年人，他们参加了冠状动脉风险发展在年轻人（CARDIA）研究的第 25 年（2010-2011 年）随访检查。我们研究了第 25 年 C 端 FGF23 浓度与索引 LVM（LVMI=LVM/身高）、LVH 和斑点跟踪应变超声心动图评估的心肌应变之间的关系。在返回第 30 次检查的 2758 名（88.6%）参与者中，我们还研究了第 25 年 FGF23 与 5 年 LVM 变化、应变参数和新发 LVH 的关系。
平均年龄为 50.0（±3.6）岁，56.8%为女性，45.7%为黑人，6.4%有 CKD。第 25 年 LVH 的患病率为 6.0%。5 年 LVM 的平均变化为 5.3（±7.7）克/米。在多变量模型中，与较低四分位数相比，FGF23 最高四分位数与第 25 年更高的 LVH 几率相关。[比值比 95%置信区间：1.81（1.28，2.58）]，排除 CKD 患者后也有类似发现。FGF23 与种族（P=.18）或性别（P=.80）之间没有相互作用。FGF23 与整体纵向应变之间没有关联。FGF23 与 5 年 LVM 变化之间没有关联。FGF23 与 5 年新发 LVH 之间没有关联。
在没有已知 CVD 或 CKD 的中年人群中，较高的 FGF23 与更高的 LVH 几率相关，但与随时间推移 LVM 的更大增加无关。需要进一步研究以阐明 FGF23 是否是 LVH 的潜在风险标志物，还是无 CKD 的年轻和中年人群中随时间推移 LVM 增加的机制。
