Original InvestigationPathogenesis and Treatment of Kidney DiseaseAssociation of Serum Phosphorus With Left Ventricular Mass in Men and Women With Stable Cardiovascular Disease: Data From the Heart and Soul Study
Section snippets
Participants
The Heart and Soul Study is an observational study designed to evaluate the association of psychological factors and CVD. Methods have been described previously.20 Briefly, participants with prevalent CVD, defined as history of myocardial infarction, angiographic evidence of >50% stenosis in 1 or more coronary vessels, evidence of exercise-induced ischemia using treadmill or nuclear stress testing, or history of coronary revascularization, were recruited from outpatient clinics in the San
Results
Mean age of the 978 study participants was 67 years. The study recruited heavily from a Veterans Affairs medical center; therefore, 19% (n = 181) were women. Thirty percent had moderate CKD (eGFRCysC <60 mL/min/1.73 m2). Mean serum phosphorus level was 3.7 ± 0.6 mg/dL overall; however, this differed by sex (3.6 ± 0.5 mg/dL in men and 4.0 ± 0.7 mg/dL in women; P < 0.001). Baseline characteristics by phosphorus tertiles are listed separately for men and women (Table 1, Table 2, respectively). In
Discussion
In this study of outpatients with stable CVD, higher serum phosphorus levels were associated with greater LV mass in men, but not women. Two prior studies conducted in the ARIC cohort showed that associations of phosphorus levels with carotid intima media thickness and CVD events were limited to men.4, 15 The sex difference in the association of phosphorus level with LV mass shown here provides additional evidence supporting unique relationships of phosphorus levels with CVD in men and women in
Acknowledgements
Dr Saab acknowledges the Harry S. Truman VA Hospital for providing the facility space for the design of this analysis and drafting of the manuscript. Results of this study were presented as a poster in abstract form at the 2009 ASN Renal Week, October 31, 2009, San Diego, CA.
Support: Dr Ix is funded by a grant from the American Heart Association Fellow-to-Faculty Transition Award. The Heart and Soul Study was funded by the Department of Veterans Affairs, American Federation for Aging Research,
References (38)
- et al.
Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study
Am J Kidney Dis
(1998) - et al.
Hyperphosphatemia aggravates cardiac fibrosis and microvascular disease in experimental uremia
Kidney Int
(2003) - et al.
Adverse effects of hyperphosphatemia on myocardial hypertrophy, renal function, and bone in rats with renal failure
Kidney Int
(2004) - et al.
Phosphorus levels are associated with subclinical atherosclerosis in the general population
Atherosclerosis
(2008) - et al.
Serum phosphorus concentrations in the Third National Health and Nutrition Examination Survey (NHANES III)
Am J Kidney Dis
(2009) - et al.
Estrogen downregulates the proximal tubule type IIa sodium phosphate cotransporter causing phosphate wasting and hypophosphatemia
Kidney Int
(2008) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Prognostic significance of increased left ventricular mass index to mortality and sudden death in patients with stable coronary heart disease (from the Heart and Soul Study)
Am J Cardiol
(2008) - et al.
Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD
Am J Kidney Dis
(2008) - et al.
Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the Multi-Ethnic Study of Atherosclerosis (MESA)
Am J Kidney Dis
(2008)
Effect of hemoglobin levels on cardiovascular outcomes in patients with isolated systolic hypertension and left ventricular hypertrophy (from the LIFE Study)
Am J Cardiol
The effect of hormone replacement therapy on postmenopausal bone loss
Eur J Obstet Gynecol Reprod Biol
Mineral metabolism, mortality, and morbidity in maintenance hemodialysis
J Am Soc Nephrol
Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community
Arch Intern Med
Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality
Am J Epidemiol
Relation between serum phosphate level and cardiovascular event rate in people with coronary disease
Circulation
Phosphate regulation of vascular smooth muscle cell calcification
Circ Res
Association of serum phosphate concentrations with vascular and valvular calcification in moderate chronic kidney disease: the Multi-Ethnic Study of Atherosclerosis
J Am Soc Nephrol
Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis
N Engl J Med
Cited by (36)
The Other Way Around: Living With Chronic Kidney Disease From the Perspective of Men
2022, Seminars in NephrologyUpdate on Chronic Kidney Disease Mineral and Bone Disorder in Cardiovascular Disease
2018, Seminars in NephrologyCitation Excerpt :In many human studies, abnormalities of MBD components including phosphorus, vitamin D, PTH, and FGF23 associate with adverse changes in cardiac structure or function that are independent of static blood pressure.16,18,53,110 Relationships of higher FGF23 with left ventricular hypertrophy, concentric and eccentric remodeling, and diastolic dysfunction are some of the most widely reported, with independent associations found in adults and children with and without kidney disease.31,111-117 Experiments in preclinical models have suggested that these associations may be the result of direct effects of FGF23 on the myocardium,113,118,119 owing to biased signaling via FGF receptor 4 without klotho as a co-receptor.120,121
Serum phosphorus is related to left ventricular remodeling independent of renal function in hospitalized patients with chronic kidney disease
2016, International Journal of CardiologyCitation Excerpt :In another community-dwelling study with young adults (mean age 25 years), serum phosphorus 5 years earlier was also associated with LVMI (7.1 g/m2 for each 1 mmol/L increment in serum phosphorus) and the prevalence of LVH, with the significance mainly presented in the fifth quintile phosphorus levels (> 4.0 mg/dl) [18]. In a study with stable CVD outpatients, higher serum phosphorus was associated with greater LVMI in men (4.5 g/m2 increase for each 1 mmol/L increment in serum phosphorus), but not in women [19]. The association between serum phosphorus and left ventricular mass was greatly strengthened in CKD outpatients with stage 2 to stage 4 using cardiac magnetic resonance (16.7 g/m2 increase for each 1 mmol/L increment in serum phosphorus) [20].
Determinants of phosphorus mobilization during hemodialysis
2013, Kidney InternationalCitation Excerpt :In addition, Saab et al.28 have recently demonstrated in outpatients with stable cardiovascular disease that higher serum phosphorus concentrations are associated with greater left ventricular mass in men, but not in women. These previous studies suggest that serum phosphorus concentrations and their relationship with cardiovascular disease are influenced by patient sex, perhaps by the influence of hormonal differences.28,29 Thus, the sex differences we observed in phosphorus mobilization clearance are not incompatible with other findings related to serum phosphorus concentration in other patient groups.
Phosphate homeostasis in CKD: Report of a scientific symposium sponsored by the national kidney foundation
2013, American Journal of Kidney DiseasesCitation Excerpt :Whether higher phosphate level is linked to CVD and death in geographic regions with different indigenous dietary patterns is uncertain. Third, several studies have suggested that the relationships between serum phosphate concentrations with subclinical and clinical CVD outcomes may differ by sex and menopausal status.92-94 Race/ethnic differences have not been fully explored.27,51,95
Originally published online as doi:10.1053/j.ajkd.2010.03.030 on June 28, 2010.