Relations of Serum Phosphorus Levels to Echocardiographic Left Ventricular Mass and Incidence of Heart Failure in the Community
Open accessAbstract
Aims: To evaluate the association of serum phosphorus with cardiac structure/function and incident heart failure. Methods and results: We related serum phosphorus to echocardiographic left ventricular (LV) measurements cross-sectionally, and to incident heart failure prospectively in 3300 participants (mean age 44 years, 51% women) free of heart failure, myocardial infarction, and chronic kidney disease (estimated glomerular filtration rate [eGFR]<60 mL/min/1.73 m2). Cross-sectionally, serum phosphorus was related positively to LV mass, internal dimensions, and systolic dysfunction. On follow-up (mean 17.4 years), 157 individuals developed heart failure. In models adjusting for established risk factors as time-varying covariates, each mg/dL increment in serum phosphorus was associated with a 1.74-fold risk of heart failure [95% confidence intervals (CI) 1.17–2.59]. Individuals in the highest serum phosphorus quartile experienced a two-fold (95% CI 1.28–3.40) risk of heart failure compared with participants in the lowest quartile. These relations were maintained upon additional adjustment for LV mass/dimensions and systolic dysfunction. In analyses restricted to individuals with eGFR >90 mL/min/1.73 m2, no proteinuria and serum phosphorus <4.5 mg/dL, the association of serum phosphorus with heart failure remained robust. Conclusion: In our community-based sample, higher serum phosphorus was associated with greater LV mass cross-sectionally, and with an increased risk of heart failure prospectively.
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High dietary Pi intake is associated with higher hazard ratios for cardiovascular disease and mortality in the general population.
“High dietary Pi intake has been associated with higher hazard ratios for cardiovascular disease and mortality in the general population [9, 15, 16].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [15]
High dietary Pi intake may be a health risk because higher serum Pi levels are associated with cardiovascular risk in the general population.
“may therefore be a health risk, as higher serum Pi levels are associated with cardiovascular risk in the general population.”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [15]
Further association studies suggest that higher blood Pi levels are associated with higher all-cause and cardiovascular mortality and with lower bone mass.
“further association studies suggest that higher blood Pi levels are associated with higher all-cause and cardiovascular mortality and with lower bone mass [9, 15, 16, 25, 55].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [15]
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2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536 · see citing works
Penuelas, J., Janssens, I. A., Ciais, P., Obersteiner, M., & Sardans, J. (2020) · Global Change Biology · doi:10.1111/gcb.14981 · Cited by 318 · see citing works
Fulgoni, K., & Fulgoni, V. L. (2021) · Nutrients · doi:10.3390/nu13072249 · Cited by 31 · see citing works
Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels
Gerber, J. S., Arroyo, E. M. P., Pastor, J., Correia, M., Rudloff, S., Moe, O. W., Egli-Spichtig, D., Mohebbi, N., & Wagner, C. A. (2025) · Pflügers Archiv - European Journal of Physiology · doi:10.1007/s00424-024-03046-4 · Cited by 15 · see citing works
- Authors
- Dhingra, R., Gona, P., Benjamin, E. J., Wang, T. J., Aragam, J., D'Agostino, R. B., Kannel, W. B., & Vasan, R. S.
- Affiliations
- Dartmouth–Hitchcock Medical Center (US)
- Boston University (US)
- Harvard University (US)
- United States Department of Veterans Affairs (US)
- National Heart, Lung, and Blood Institute's Framingham Heart Study , 73 Mount Wayte Avenue, Suite 2, Framingham, MA ,
- Corresponding author
- Vasan, Ramachandran S.
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-08-01
- Volume
- 12
- Issue
- 8
- Pages
- 812-818
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- PMC
- PMC2913049
- OpenAlex
- W2164878834
- Cited by
- 108
- References
- 1
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 8 · 2016: 9 · 2015: 9 · 2014: 11 · 2013: 12 · 2012: 10
- FWCI
- 6.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc25195-41-0-1, 5r01hl080124-05, N01-HC 25195)
- National Heart, Lung, and Blood Institute (2K24HL4334, N01‐HC25195, HL 080124, K24HL004334)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- serum phosphorus, hyperphosphatemia, left ventricular mass, heart failure incidence, systolic dysfunction, left ventricular dimensions, community-based cohort, cardiovascular risk factors
- MeSH terms
- Adult, Computer Simulation, Cross-Sectional Studies, Echocardiography, Female, Glomerular Filtration Rate, Heart Failure, Heart Ventricles, Humans, Male, Phosphorus, Prospective Studies, Residence Characteristics, Risk Factors, Systole, United States, Incidence, Multivariate Analysis, Confidence Intervals, Logistic Models, Proportional Hazards Models, Hypertrophy, Left Ventricular, Disease Progression, Risk Assessment
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