Fibroblast growth factor 23, the ankle-brachial index, and incident peripheral artery disease in the Cardiovascular Health Study

• Published in: Atherosclerosis 2014-03, Vol.233 (1), p.91-96
• Main Authors: Garimella, Pranav S, Ix, Joachim H, Katz, Ronit, Chonchol, Michel B, Kestenbaum, Bryan R, de Boer, Ian H, Siscovick, David S, Shastri, Shani, Hiramoto, Jade S, Shlipak, Michael G, Sarnak, Mark J
• Format: Article
• Language: English
• Subjects: Aged; Ankle Brachial Index; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - physiopathology; Chronic kidney disease; Cross-Sectional Studies; Fibroblast growth factor; Fibroblast Growth Factor-23; Fibroblast Growth Factors - blood; Humans; Incidence; Peripheral Arterial Disease - blood; Peripheral Arterial Disease - epidemiology; Peripheral artery disease; Risk Factors
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2013.12.015

Abstract Background Fibroblast growth factor 23 (FGF23) has emerged as a novel risk factor for mortality and cardiovascular events. Its association with the ankle-brachial index (ABI) and clinical peripheral artery disease (PAD) is less known. Methods Using data ( N  = 3143) from the Cardiovascular Health Study (CHS), a cohort of community dwelling adults >65 years of age, we analyzed the cross-sectional association of FGF23 with ABI and its association with incident clinical PAD events during 9.8 years of follow up using multinomial logistic regression and Cox proportional hazards models respectively. Results The prevalence of cardiovascular disease (CVD) and traditional risk factors like diabetes, coronary artery disease, and heart failure increased across higher quartiles of FGF23. Compared to those with ABI of 1.1–1.4, FGF23 per doubling at baseline was associated with prevalent PAD (ABI 1.4) (OR 1.06, 95% CI 0.75–1.51). Higher FGF23 was associated with incidence of PAD events in unadjusted, demographic adjusted, and CVD risk factor adjusted models (HR 2.26, 95% CI 1.28–3.98; highest versus lowest quartile). The addition of estimated glomerular filtration and urine albumin to creatinine ratio to the model however, attenuated these findings (HR 1.46, 95% CI, 0.79–2.70). Conclusions In community dwelling older adults, FGF23 was not associated with baseline low or high ABI or incident PAD events after adjusting for confounding variables. These results suggest that FGF23 may primarily be associated with adverse cardiovascular outcomes through non atherosclerotic mechanisms.