Plasma fibroblast growth factor 23 and risk of cardiovascular disease: results from the EPIC-Germany case-cohort study
Plasma fibroblast growth factor 23 and risk of cardiovascular disease: results from the EPIC-Germany case-cohort study
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DOI：
10.1007/s10654-014-9982-4
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发表时间：
2015-02-01
影响因子：
13.6
通讯作者：
Weikert, Cornelia
中科院分区：
文献类型：
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作者：
di Giuseppe, Romina;Kuehn, Tilmann;Weikert, Cornelia
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的研究是在冠心病(CAD)患者和老年人中进行的。在没有冠心病和中风亚型的受试者中，证据尚不清楚。我们研究了FGF23与总体主要心血管终点、心梗发生率、缺血性中风(IS)和出血性中风(HS)之间的关系。我们使用了嵌套在欧洲癌症和营养前瞻性调查-德国的病例队列研究，包括在平均8.2年的随访中确定的随机抽取的亚队列(n=1,978)，急性心肌梗塞(n=463)和中风病例(n=359 IS；n=88 HS)。与FGF23水平在最低四分位数的参与者相比，那些处于最高四分位数的参与者在调整已确定的心血管危险因素、帕金森激素和25-羟基维生素D3水平、饮食钙磷摄入量和肾功能后，心血管事件的风险增加36%[风险比：1.36，95%可信区间：1.02-1.82]。然而，子分析显示与MI和HS的风险有显著关系，但不是。与最低四分位数相比，前两个FGF23四分位数的个体患MI的风险增加1.62倍(95%可信区间1.07-2.45)，患HS的风险增加2.61倍(95%可信区间1.23-5.52)。FGF23升高成为MI和HS的危险因素。有必要进行进一步的研究来证实这些结果并确定潜在的机制。
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.