Is FGF-23 an early indicator of atherosclerosis and cardiac dysfunction in patients with gestational diabetes?

Abstract

Objective: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone and plays a role in the pathogenesis of myocardial hypertrophy. The aim of this study was to evaluate the association of FGF-23 levels with echocardiographic parameters and insulin resistance (IR) in patients with gestational diabetes. Subjects and methods: Fifty-four pregnant patients with gestational diabetes mellitus (GDM) (age, 31.12 ± 5.72 years) and 33 healthy pregnant women (age, 29.51 ± 4.92 years) were involved in the study. Fasting insulin, fasting plasma glucose (FPG), lipid profile, oral glucose tolerance test (OGTT), FGF23, echocardiographic parameters, and carotid artery intima-media thickness (CIMT) were evaluated in the two groups. Results: The two groups were not significantly different in age, sex, body mass index, lipid profile, or blood pressure. Insulin, homeostatic model assessment-insulin resistance (HOMA-IR), FGF-23 levels, CIMT, left ventricular (LV) mass, LV mass index and myocardial performance index (MPI) were significantly higher in the GDM group. HOMA-IR was positively correlated with FGF-23, and insulin was positively correlated with FGF-23. Additionally, FGF-23 was positively correlated with CIMT, LV mass index, and MPI. Conclusion: Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with GDM.

New developments in the biology of fibroblast growth factors

“…However, in patients with T2D, serum FGF21 levels correlate with carotid intima‐media thickness and were predictive of subclinical atherosclerosis (Yafei et al, 2019), and serum FGF23 levels were independently and positively correlated with lower extremity atherosclerotic disease (He et al, 2017). In patients with gestational diabetes, serum FGF23 levels positively correlated with subclinical atherosclerosis as assessed by carotid artery intima‐media thickness (Tuzun et al, 2018).…”

Hyperphosphatemia and Cardiovascular Disease

“…Multiple linear regression analysis also showed that FGF-23 could increase the risk of carotid atherosclerotic plaque, which reflects systemic peripheral atherosclerosis (Rodríguez-Ortiz et al, 2020). Tuzun et al (2018) included 54 pregnant women with gestational diabetes mellitus (GDM) and 33 healthy pregnant women, and using color to predict the degree of atherosclerosis, it was found that FGF-23 in GDM group was significantly higher than that in the control group, and the increase of FGF-23 was positively correlated with doppler ultrasound evaluated carotid intima-media thickness. In addition, FGF-23 could increase the recognition rate of the Framingham risk score for carotid atherosclerosis (Hu et al, 2017).…”

Fibroblast growth factor-23 is associated with imaging markers of diabetic cardiomyopathy and anti-diabetic therapeutics

“…The beneficial effect was evident in both patients with and without chronic kidney disease but did seem to be numerically greater in patients with eGFR < 60 ml/ min/1.73 m 2 , who should also be expected to have the highest levels of circulating FGF-23. In patients with gestational diabetes, FGF-23 may be a promising indicator of subclinical arteriosclerosis [36], and FGF-23 has previously been shown to be positively correlated with the development of coronary atherosclerosis [37]. The anti-atherosclerotic effect of GLP-1 analogues has been suggested as an explanation for the reduction in cardiovascular morbidity and mortality associated with GLP-1 therapy [38], whereas very little data exists on how GLP-1 therapy affects the myocardial microcirculation.…”