期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 11, 期 15, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.121.024952
关键词
fibroblast growth factor 23; general population; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction
This study found a significant association between higher FGF23 levels and new-onset HFrEF, but the association with HFpEF lost statistical significance after adjusting for potential confounders.
Background The role of fibroblast growth factor 23 (FGF23) in the development of new-onset heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF) in the general population is unknown. Therefore, we set out to investigate associations of C-terminal FGF23 with development of new-onset HF and, more specifically, with HFrEF or HFpEF in a large, prospective, population-based cohort. Methods and Results We studied 6830 participants (aged 53.8 +/- 12.1 years; 49.7% men; estimated glomerular filtration rate, 93.1 +/- 15.7 mL/min per 1.73 m(2)) in the community-based PREVEND (Prevention of Renal and Vascular End-Stage Disease) study who were free of HF at baseline. Cross-sectional multivariable linear regression analysis showed that ferritin (standardized beta, -0.24; P<0.001) and estimated glomerular filtration rate (standardized beta, -0.13; P<0.001) were the strongest independent correlates of FGF23. Multivariable Cox proportional hazard regression was used to study the association between baseline FGF23 and incident HF, HFrEF (ejection fraction <= 40%) or HFpEF (ejection fraction >= 50%). After median follow-up of 7.4 [IQR 6.9-7.9] years, 227 individuals (3.3%) developed new-onset HF, of whom 132 had HFrEF and 88 had HFpEF. A higher FGF23 level was associated with an increased risk of incident HF (fully adjusted hazard ratio, 1.29 [95% CI, 1.06-1.57]) and with an increased risk of incident HFrEF (fully adjusted hazard ratio, 1.31 [95% CI, 1.01-1.69]). The association between FGF23 and incident HFpEF lost statistical significance after multivariable adjustment (hazard ratio, 1.22 [95% CI, 0.87-1.71]). Conclusions Higher FGF23 is independently associated with new-onset HFrEF in analyses fully adjusted for cardiovascular risk factors and other potential confounders. The association between FGF23 and incident HFpEF lost statistical significance upon multivariable adjustment.
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