Elevated FGF-23 associated with recurrent cardiovascular events after acute coronary syndrome

1. Elevated FGF-23 concentration was associated with increased risk of adverse cardiovascular (CV) outcomes, including CV death and heart failure hospitalization.

2. Elevated FGF-23 was also associated with increased risk of all-cause mortality.

Evidence Rating Level: 2 (Good)

Study Rundown: Fibroblast growth factor 23 (FGF-23) is a protein hormone that inhibits renal reabsorption of phosphate and activation of vitamin D. Elevated FGF-23 has previously been linked to adverse CV outcomes in patients without established CV disease and in those with stable coronary artery disease and preserved left-ventricular ejection fraction. This study examines the prognostic utility of FGF-23 in patients after a recent ACS. The authors find that the patients in the top quartile of FGF-23 concentrations had an elevated risk for CV death or heart failure hospitalization, as well as an increased risk of all-cause mortality, CV death, MI, stroke, and atrial fibrillation. The association with CV death or heart failure hospitalization was attenuated in women. Despite being observational in nature, this study reveals a potential biomarker of adverse CV outcomes that is separate from traditional CV biomarkers, and strengthens the association of elevated FGF-23 with cardiac remodeling, heart failure, and ischemic events.

Click to read the study, published in JAMA Cardiology

Relevant Reading: Elevated fibroblast growth factor-23 and risk of cardiovascular disease or mortality in the general population: a meta-analysis

In-Depth [retrospective cohort study]: In this study, the authors determined an association between FGF-23 concentrations and the risk of CV death or heart failure hospitalization in a cohort of 4947 patients from the Stabilization of Plaques Using Darapladib-Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) trial. Patients in the top quartile of FGF-23 concentrations had a higher risk of CV death or heart failure hospitalization compared to patients in other quartiles (adjusted HR, 2.35; 95% CI, 1.82-3.02; p < 0.001). Additionally, those in the top quartile also had an increased risk of all-cause mortality, CV death, MI, stroke, and atrial fibrillation. In general, women had a higher baseline median FGF-23 concentration than men. In terms of the association with CV death or heart failure hospitalization, women had an attenuated association with FGF-23 (women: HR, 1.11; 95%, 0.70-1.76; p = 0.67; men: HR, 3.11; 95% CI, 2.29-4.22; p < 0.001).

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