Coexistence of Low Vitamin D and High Fibroblast Growth Factor-23 Plasma Levels Predicts an Adverse Outcome in Patients with Coronary Artery Disease

Abstract

ObjectiveVitamin D and fibroblast growth factor-23 (FGF-23) are related with cardiovascular disorders. We have investigated the relationship of calcidiol (vitamin D metabolite) and FGF-23 plasma levels with the incidence of adverse outcomes in patients with coronary artery disease.MethodsProspective follow-up study of 704 outpatients, attending the departments of Cardiology of four hospitals in Spain, 6–12 months after an acute coronary event. Baseline calcidiol, FGF-23, parathormone, and phosphate plasma levels were assessed. The outcome was the development of acute ischemic events (any acute coronary syndrome, stroke, or transient ischemic attack), heart failure, or death. Cox regression adjusted for the main confounders was performed.ResultsCalcidiol levels showed a moderate-severe decrease in 57.3% of cases. Parathormone, FGF-23, and phosphate levels were increased in 30.0%, 11.5% and 0.9% of patients, respectively. Only 22.4% of patients had glomerular filtration rate<60 ml/min1.73 m2. After a mean follow-up was 2.15±0.99 years, 77 patients developed the outcome. Calcidiol (hazard ratio [HR] = 0.67; 95% confidence interval [CI] = 0.48–0.94; p = 0.021) and FGF-23 (HR = 1.13; 95% CI = 1.04–1.23; p = 0.005) plasma levels predicted independently the outcome. There was a significant interaction between calcidiol and FGF-23 levels (p = 0.025). When the population was divided according to FGF-23 levels, calcidiol still predicted the outcome independently in patients with FGF-23 levels higher than the median (HR = 0.50; 95% CI = 0.31–0.80; p = 0.003) but not in those with FGF-23 levels below this value (HR = 1.03; 95% CI = 0.62–1.71; p = 0.904).ConclusionsAbnormalities in mineral metabolism are frequent in patients with stable coronary artery disease. In this population, low calcidiol plasma levels predict an adverse prognosis in the presence of high FGF-23 levels.

Relationship of fibroblast growth factor 23 and fetuin-A to coronary atherosclerosis

“…It was recently demonstrated that Klotho, which determines the tissue-specific signaling of FGF-23, is expressed in human arteries and human aortic smooth muscle cells (Donate-Correa et al, 2013), suggesting that FGF-23 could affect vascular tissues in an endocrine fashion (Lim et al, 2012). FGF-23 may also modulate progression and development of coronary atherosclerosis through inhibition of vitamin D activation (Tuñón et al, 2014).…”

Associations of Fibroblast Growth Factor 23 and Fetuin-A with Coronary Plaque Burden and Plaque Composition in Young Adults

“…Fibroblast growth factor 23 may also modulate progression and development of coronary atherosclerosis through its inhibition of vitamin D activation. 25 …”

Fibroblast growth factor 23 as novel biomarker for early risk stratification after ST-elevation myocardial infarction

“…Interestingly, the relationship between FGF-23 levels and CV mortality was also reported for patients with no CKD3 and for community-living individuals 4. FGF-23 was shown to be a strong predictor of CV mortality in patients with coronary artery disease (CAD),5 as well as in patients with acute or chronic heart failure (HF) 6 7…”