Clinical research studySerum Phosphorus and Cardiovascular Mortality in Type 2 Diabetes
Section snippets
Study Design and Participants
This is a post hoc analysis of the Appropriate Blood-pressure Control in Diabetes (ABCD) trial, which evaluated the effects of intensive versus moderate blood pressure control on diabetic microvascular and macrovascular complications.11, 12 In the ABCD trial, 950 patients with type 2 diabetes mellitus were assigned randomly to one of 2 treatment arms: intensive treatment with a diastolic blood pressure goal of 75 mm Hg or moderate treatment with a diastolic blood pressure goal of 80-89 mm Hg.
Results
Baseline characteristics for the entire group by phosphorus level are summarized in Table 1. Data show that there were higher non-HDL cholesterol and calcium levels, and lower estimated GFR in subjects in the higher quartiles of phosphorus. The lowest prevalence of overt albuminuria occurred in the subjects in the middle 2 quartiles of phosphorus. Of note, the mean serum phosphorus level was significantly lower (P <.01) in males (3.43 ± 0.47 mg/dL) than in females (3.76 ± 0.49).
The mean follow-up
Conclusions
In a study cohort of type 2 diabetic patients with normal or near-normal kidney function, higher baseline fasting serum phosphorus and calcium-phosphorus product were associated with cardiovascular mortality independent of other important confounders, whereas in time-dependent models, only serum phosphorus was independently related to the outcome. Although the findings obtained with baseline covariate Cox regression models are confirmatory of observations made by Tonelli et al5 and Dhingra et al
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Cited by (53)
Management of Mineral and Bone Disorders in Chronic Kidney Disease
2019, Chronic Renal DiseaseLow serum phosphate and magnesium levels are associated with peripheral neuropathy in patients with type 2 diabetes mellitus
2018, Diabetes Research and Clinical PracticeSerum phosphorus is related to left ventricular remodeling independent of renal function in hospitalized patients with chronic kidney disease
2016, International Journal of CardiologySerum phosphorus levels are associated with endothelial dysfunction in hypertensive patients
2016, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :It is well known that the pathogenesis of endothelial dysfunction is multifactorial, involving many of the clinical conditions leading to an increased oxidative stress and subclinical inflammation [13,14]. Recent published data reported that elevated serum phosphorus concentrations, even if within the normal range, emerged as a non-traditional risk factor for CV events in patients with high CV risk conditions such as chronic kidney disease [15,16], coronary or peripheral artery diseases [17,18], diabetes [19] as well as in the general population [20,21]. Finally, recent data reported that acute postprandial phosphorus load is inversely correlated with endothelium-dependent vasodilation in young healthy men, evaluated by brachial flow-mediated vasodilation [22].
Management of Mineral and Bone Disorders in Chronic Kidney Disease Patients
2015, Chronic Renal DiseaseBioavailable dietary phosphate, a mediator of cardiovascular disease, may be decreased with plant-based diets, phosphate binders, niacin, and avoidance of phosphate additives
2014, NutritionCitation Excerpt :In recent prospective epidemiologic analyses, serum phosphate within the normal physiological range has been found to correlate positively and monotonically with risk for cardiovascular events, new heart failure, and cardiovascular and all-cause mortality [1–8]; an excellent summary of these data in tabular form was provided previously [9].
Funding: Clinical revenues.
Conflict of Interest: None.
Authorship: All authors participated in the conception and design of the study, the interpretation of data, drafting and critical revision of the manuscript, and have read and approved the manuscript.