Fibroblast growth factor-23 and incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS).
Fibroblast growth factor-23 and incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS).
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DOI：
10.1161/circulationaha.113.005499
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发表时间：
2014-07-22
期刊：
影响因子：
37.8
通讯作者：
de Boer IH
中科院分区：
文献类型：
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作者：
Mathew JS;Sachs MC;Katz R;Patton KK;Heckbert SR;Hoofnagle AN;Alonso A;Chonchol M;Deo R;Ix JH;Siscovick DS;Kestenbaum B;de Boer IH
成纤维细胞生长因子-23（FGF-23）是一种促进尿磷酸盐排泄和调节维生素D代谢的激素。循环FGF-23浓度在慢性肾脏疾病中显著增加，并与临床心血管事件风险增加相关。FGF-23可能通过诱导左心室肥大、舒张和左心房功能障碍而促进心房颤动（AF）。我们在多种族动脉粥样硬化研究（梅萨）的6，398名参与者和心血管健康研究（CHS）的1，350名参与者中测试了循环FGF-23浓度与AF事件的相关性，所有参与者在基线时均无临床心血管疾病。在7.7年和8.0年的中位随访中，我们分别在梅萨和CHS中观察到291例和229例AF事件。在多变量考克斯比例风险模型中，在梅萨中，FGF-23浓度每增加2倍与AF事件风险增加41%相关（HR 1.41 [95% CI 1.13-1.76]，p=0.003），CHS中AF事件的风险高30%（HR 1.30 [95% CI 1.05-1.61]，p=0.016），调整潜在混杂特征，包括肾脏疾病。血清磷酸盐浓度与梅萨中的AF事件显著相关（HR 1.15/0.5 mg/dL [CI 1.02-1.31]，p值=0.023），但与CHS无关。在梅萨中，通过调整FGF-23，低估计肾小球滤过率与AF事件的相关性部分减弱。较高的循环FGF-23浓度与AF事件相关，并可能部分解释慢性肾脏疾病与AF之间的联系。
Fibroblast growth factor-23 (FGF-23) is a hormone that promotes urinary phosphate excretion and regulates vitamin D metabolism. Circulating FGF-23 concentrations increase markedly in chronic kidney disease and are associated with increased risk of clinical cardiovascular events. FGF-23 may promote atrial fibrillation (AF) by inducing left ventricular hypertrophy and diastolic and left atrial dysfunction. We tested associations of circulating FGF-23 concentration with incident AF among 6,398 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and 1,350 participants in the Cardiovascular Health Study (CHS), all free of clinical cardiovascular disease at baseline. Over 7.7 and 8.0 years median follow-up, we observed 291 and 229 incident AF events in MESA and CHS, respectively. In multivariable Cox proportional hazards models, each two-fold higher FGF-23 concentration was associated with a 41% higher risk of incident AF in MESA (HR 1.41 [95% CI 1.13-1.76], p=0.003) and a 30% higher risk of incident AF in CHS (HR 1.30 [95% CI 1.05-1.61], p=0.016), adjusting for potential confounding characteristics including kidney disease. Serum phosphate concentration was significantly associated with incident AF in MESA (HR 1.15 per 0.5 mg/dL [CI 1.02-1.31], p-value=0.023) but not CHS. In MESA, an association of low estimated glomerular filtration rate with incident AF was partially attenuated by adjusting for FGF-23. Higher circulating FGF-23 concentration is associated with incident AF and may, in part, explain the link between chronic kidney disease and AF.