TY - JOUR T1 - Fibroblast growth factor-23 and incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS). JF - Circulation Y1 - 2014 A1 - Mathew, Jehu S A1 - Sachs, Michael C A1 - Katz, Ronit A1 - Patton, Kristen K A1 - Heckbert, Susan R A1 - Hoofnagle, Andrew N A1 - Alonso, Alvaro A1 - Chonchol, Michel A1 - Deo, Rajat A1 - Ix, Joachim H A1 - Siscovick, David S A1 - Kestenbaum, Bryan A1 - de Boer, Ian H KW - Aged KW - Aged, 80 and over KW - Atrial Fibrillation KW - Comorbidity KW - Ethnic Groups KW - Female KW - Fibroblast Growth Factor 3 KW - Follow-Up Studies KW - Glomerular Filtration Rate KW - Heart Failure KW - Humans KW - Hypertrophy, Left Ventricular KW - Male KW - Middle Aged KW - Phosphates KW - Proportional Hazards Models KW - Renal Insufficiency, Chronic KW - Risk Factors KW - United States KW - Ventricular Dysfunction, Left KW - Ventricular Remodeling KW - Vitamin D AB -

BACKGROUND: Fibroblast growth factor-23 (FGF-23) is a hormone that promotes urinary phosphate excretion and regulates vitamin D metabolism. Circulating FGF-23 concentrations increase markedly in chronic kidney disease and are associated with increased risk of clinical cardiovascular events. FGF-23 may promote atrial fibrillation (AF) by inducing left ventricular hypertrophy and diastolic and left atrial dysfunction.

METHODS AND RESULTS: We tested the associations of circulating FGF-23 concentration with incident AF among 6398 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and 1350 participants in the Cardiovascular Health Study (CHS), all free of clinical cardiovascular disease at baseline. Over a median of 7.7 and 8.0 years of follow-up, we observed 291 and 229 incident AF events in MESA and CHS, respectively. In multivariable Cox proportional hazards models, each 2-fold-higher FGF-23 concentration was associated with a 41% higher risk of incident AF in MESA (hazard ratio, 1.41; 95% confidence interval, 1.13-1.76; P=0.003) and a 30% higher risk of incident AF in CHS (hazard ratio, 1.30; 95% confidence interval, 1.05-1.61; P=0.016) after adjustment for potential confounding characteristics, including kidney disease. Serum phosphate concentration was significantly associated with incident AF in MESA (hazard ratio, 1.15 per 0.5 mg/dL; 95% confidence interval, 1.02-1.31; P=0.023) but not CHS. In MESA, an association of low estimated glomerular filtration rate with incident AF was partially attenuated by adjustment for FGF-23.

CONCLUSION: Higher circulating FGF-23 concentration is associated with incident AF and may, in part, explain the link between chronic kidney disease and AF.

VL - 130 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24920722?dopt=Abstract ER -