Phosphorus Is Associated with Coronary Artery Disease in Patients with Preserved Renal Function

High serum phosphorus levels have been associated with mortality and cardiovascular events in patients with chronic kidney disease and in the general population. In addition, high phosphorus levels have been shown to induce vascular calcification and endothelial dysfunction in vitro. The aim of this study was to evaluate the relation of phosphorus and coronary calcification and atherosclerosis in the setting of normal renal function. This was a cross-sectional study involving 290 patients with suspected coronary artery disease and undergoing elective coronary angiography, with a creatinine clearance >60 ml/min/1.73 m2. Coronary artery obstruction was assessed by the Friesinger score and coronary artery calcification by multislice computed tomography. Serum phosphorus was higher in patients with an Agatston score >10 than in those with an Agatston score ≤10 (3.63±0.55 versus 3.49±0.52 mg/dl; p = 0.02). In the patients with Friesinger scores >4, serum phosphorus was higher (3.6±0.5 versus 3.5±0.6 mg/dl, p = 0.04) and median intact fibroblast growth factor 23 was lower (40.3 pg/ml versus 45.7 pg/ml, p = 0.01). Each 0.1-mg/dl higher serum phosphate was associated with a 7.4% higher odds of having a Friesinger score >4 (p = 0.03) and a 6.1% greater risk of having an Agatston score >10 (p = 0.01). Fibroblast growth factor 23 was a negative predictor of Friesinger score (p = 0.002). In conclusion, phosphorus is positively associated with coronary artery calcification and obstruction in patients with suspected coronary artery disease and preserved renal function

Univariate and multivariate logistic regression analysis of the risk of having an Agatston score >10.

<p>Univariate and multivariate logistic regression analysis of the risk of having an Agatston score >10.</p

Univariate and multivariate logistic regression of the risk of having a Friesinger score higher than the median (4 points).

<p>Univariate and multivariate logistic regression of the risk of having a Friesinger score higher than the median (4 points).</p

Basic characteristics of the study population^a.

<p>BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; 25(OH)D, 25-hydroxyvitamin D; HDL, High-density lipoprotein; LDL, Low-density lipoprotein; VLDL, very low-density lipoprotein; eGFR, estimated GFR.</p>a<p>Normally distributed variables are expressed as mean ± SD and non-normally distributed variables are expressed as median (IQR).</p

Characteristics of the patients evaluated, by Agatston score^a.

<p>25(OH)D, 25-hydroxyvitamin D; PTH, parathyroid hormone; HDL, High-density lipoprotein; LDL, Low-density lipoprotein, VLDL, very low-density lipoprotein, eGFR, estimated GFR.</p>a<p>Normally distributed variables are expressed as mean ± SD and non-normally distributed variables are expressed as median (IQR).</p

Agatston scores by serum phosphorus tertiles.

<p>Results are expressed as medians. Agatston scores were progressively higher across phosphorus tertiles (<i>P</i> = 0.01).</p