Fibroblast growth factor-23 and cardiovascular disease in the general population the multi-ethnic study of atherosclerosis

Bryan Kestenbaum, Michael C. Sachs, Andy N. Hoofnagle, David S. Siscovick, Joachim H. Ix, Cassianne Robinson-Cohen, Joao A.C. Lima, Joseph F. Polak, Marc Blondon, John Ruzinski, Denise Rock, Ian H. De Boer

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


Background: Fibroblast growth factor-23 (FGF-23) is a phosphate regulatory hormone that directly stimulates left ventricular hypertrophy in experimental models. The role of FGF-23 in cardiovascular disease development in the general population is unclear. We tested associations of FGF-23 with major subclinical and clinical cardiovascular disease outcomes in a large prospective cohort. Methods and Results: We evaluated 6547 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who were initially free of cardiovascular disease. We measured serum FGF-23 using the Kainos immunoassay. The MESA measured left ventricular mass by MRI, coronary calcium by computed tomography, and carotid intima-media thickness by ultrasound. The MESA adjudicated incident heart failure, coronary heart disease, and stroke by medical record review. After adjustment, the highest FGF-23 quartile was associated with an estimated 2.4-g greater left ventricular mass (95% confidence interval, 0.4-4.5 greater) and a 26% greater odds of higher coronary calcium scores (95% confidence interval, 9%-46% greater) compared with the lowest quartile. During 7.5-year follow-up, each 20-pg/mL higher FGF-23 concentration was associated with a 19% greater risk of heart failure (95% confidence interval, 3%-37% greater) and a 14% greater risk of coronary heart disease (95% confidence interval, 1%-28% greater). FGF-23 was not associated with carotid intima-media thickness or stroke. Conclusions: Higher serum FGF-23 concentrations are associated with subclinical cardiac disease and with new heart failure and coronary disease events, but not with carotid intima-media thickness or stroke. FGF-23 may be a novel cardiovascular risk factor in the general population.

Original languageEnglish (US)
Pages (from-to)409-417
Number of pages9
JournalCirculation: Heart Failure
Issue number3
StatePublished - May 2014


  • Cardiovascular diseases
  • Carotid intima-media thickness
  • Coronary disease
  • Fibroblast growth factor 23
  • Heart failure
  • Hypertrophy
  • Left ventricular
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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