Cardiovascular disease remains the leading cause of death world wide. Although atheroma is clearly important, the role of arteriosclerotic vascular disease is often overlooked. Arteriosclerosis causes increased arterial stiffness, with consequent systolic hypertension and left ventricular hypertrophy. Serum phosphate is increasingly being recognised as a cardiovascular risk factor and has been implicated in the development of arteriosclerosis and arterial calcification. Its determinants are unclear, but both diet and minor reductions in renal function may be important. Diets in affluent populations are high in phosphate because of increased consumption of animal protein and the use of phosphate-containing preservatives. This viewpoint suggests that the consumption of a phosphate-rich diet, exacerbated by the high prevalence of chronic kidney disease found in ageing populations, accelerates the development of arteriosclerosis. It is hypothesised that reducing phosphate intake will attenuate the progression of arterial stiffness with major beneficial effects upon cardiovascular mortality and morbidity.
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Competing interests All the authors are recipients of an unrestricted educational grant from Genzyme Corporation. Genzyme manufacture sevelamer, a drug licensed for the treatment of hyperphosphataemia in patients undergoing dialysis. In addition, CJF has received lecture and advisory board fees from Genzyme.
No employee from Genzyme has been involved in the preparation of the manuscript nor indeed are they aware that this manuscript has been written.
Provenance and Peer review Not commissioned; externally peer reviewed.