scholarly journals Impact of Race on the Association of Mineral Metabolism With Heart Failure: the Multi-Ethnic Study of Atherosclerosis

2019 ◽  
Vol 105 (4) ◽  
pp. e1144-e1151
Author(s):  
Cassianne Robinson-Cohen ◽  
Michael Shlipak ◽  
Mark Sarnak ◽  
Ronit Katz ◽  
Carmen Peralta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
African Americans ◽  
Ethnic Groups ◽  
Mineral Metabolism ◽  
Fibroblast Growth Factor 23 ◽  
Cox Models ◽  
Ethnic Study ◽  
Potential Risk Factors ◽  
Fgf 23

Abstract Background Alterations in mineral metabolism, such as high phosphorus, high parathyroid hormone (PTH), and high fibroblast growth factor-23 (FGF-23) have been identified as potential risk factors for heart failure (HF). Important differences in the prevalence of mineral metabolism abnormalities and in the risk of HF have been reported across race and/or ethnic groups. In this study, we evaluated whether the associations of mineral metabolism markers with HF differed by race and/or ethnicity. Methods We included participants free of cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis to quantify rates of HF overall and across race and/or ethnic groups. Using Cox models, we tested associations of baseline higher phosphorus (>4 mg/dL), PTH greater than 65 pg/mL, and FGF-23 greater than 46.5 pg/mL with incident HF, and for interactions by race and/or ethnicity, adjusting for sociodemographic and cardiovascular risk factors. Results Among the 6413 participants, median follow-up time was 14.9 years. The incidence rate for HF was highest for African Americans and lowest for Chinese (4.71 and 2.42 per 1000 person-years, respectively). The prevalence of elevated PTH (18.8% vs 7.4%) but not FGF-23 (23.1% vs 28.8%) was higher in African Americans vs Whites. In multivariable models, the associations of elevated PTH (hazard ratio [HR] 1.50, 95% CI: 1.13-1.99) and FGF-23 (HR 1.37, 95% CI: 1.07-1.75) with incident HF were statistically significant. However, the interactions by race and/or ethnicity were not statistically significant. Conclusions In a multiethnic population, higher PTH and FGF-23 were associated with risk of HF in African American and Hispanic individuals. There is no evidence that race and/or ethnicity modifies the association of altered mineral metabolism with risk of HF.

scholarly journals Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319129
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Johan Grunewald ◽  
Anders Eklund ◽  
Daniela Di Giuseppe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
General Population ◽  
Strong Predictor ◽  
Strong Association ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Clinical Predictors ◽  
Cox Models ◽  
Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

Acute Effects of an Inorganic Phosphorus Additive on Mineral Metabolism and Cardiometabolic Risk Factors in Healthy Subjects

2021 ◽  
Author(s):  
Christin Volk ◽  
Benjamin Schmidt ◽  
Corinna Brandsch ◽  
Tabea Kurze ◽  
Ulf Schlegelmilch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Healthy Subjects ◽  
Kidney Diseases ◽  
Mineral Metabolism ◽  
Fibroblast Growth Factor 23 ◽  
Inorganic Phosphorus ◽  
Dihydrogen Phosphate ◽  
Double Blind ◽  
Dietary Phosphorus ◽  
The Impact

Abstract Context Hyperphosphatemia and high levels of fibroblast growth factor 23 (FGF23) are risk factors for cardiovascular events in patients with chronic kidney diseases. However, the impact of an inorganic phosphorus additive in healthy people is largely unknown. Objective We aimed to investigate the acute effect of excessive dietary phosphorus administered as sodium dihydrogen phosphate on the postprandial levels of Pi and FGF23 and the response to food. Methods This study was a double-blind placebo-controlled crossover study with 29 healthy male and female participants from the general community who were administered a single dose of either 700 mg phosphorus (NaH2PO4) or a sodium-adjusted placebo in combination with a test meal. Postprandial plasma levels of Pi and FGF23 were measured. Results Compared with placebo, oral phosphorus increased the plasma Pi level, which remained elevated during the ensuing 8 hours (at 480 minutes: 1.31 vs 1.16 mmol/l; P < 0.001), increased urinary Pi (iAUC0-480 789 vs 95 mmol/mmol; P < 0.001), reduced tubular Pi reabsorption (iAUC0-480 −31.5 vs −6.2; P < 0.001), decreased urinary calcium (iAUC0-240 30.6 vs 53.0 mmol/mmol; P = 0.009), and stimulated the release of parathyroid hormone (iAUC0-480 2212 vs 768 ng/l; P < 0.001). However, the FGF23 levels did not change. Postprandial levels of glucose, insulin, and lipids were not substantially affected by phosphorus vs placebo. Conclusion An oral phosphorus load can induce elevated postprandial levels of circulating Pi for hours in healthy subjects, despite rapid homeostatic counterreactions. FGF23 levels and the postprandial response to food were not affected.

scholarly journals Waiting List and Kidney Transplant Vascular Risk: An Ongoing Unmet Concern

2019 ◽  
Vol 45 (1) ◽  
pp. 1-27 ◽  
Author(s):  
Domingo Hernández ◽  
Juana Alonso-Titos ◽  
Ana Maria Armas-Padrón ◽  
Veronica Lopez ◽  
Mercedes Cabello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Kidney Transplant ◽  
Mineral Metabolism ◽  
Fibroblast Growth Factor 23 ◽  
Waiting List ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Pathogenic Mechanisms

Background: Chronic kidney disease (CKD) is an important independent risk factor for adverse cardiovascular events in patients waitlisted for kidney transplantation (KT). Although KT reduces cardiovascular risk, these patients still have a higher all-cause and cardiovascular mortality than the general population. This concerning situation is due to a high burden of traditional and nontraditional risk factors as well as uremia-related factors and transplant-specific factors, leading to 2 differentiated processes under the framework of CKD, atherosclerosis and arteriosclerosis. These can be initiated by insults to the vascular endothelial endothelium, leading to vascular calcification (VC) of the tunica media or the tunica intima, which may coexist. Several pathogenic mechanisms such as inflammation-related endothelial dysfunction, mineral metabolism disorders, activation of the renin-angiotensin system, reduction of nitric oxide, lipid disorders, and the fibroblast growth factor 23-klotho axis are involved in the pathogenesis of atherosclerosis and arteriosclerosis, including VC. Summary: This review focuses on the current understanding of atherosclerosis and arteriosclerosis, both in patients on the waiting list as well as in kidney transplant recipients, emphasizing the cardiovascular risk factors in both populations and the inflammation-related pathogenic mechanisms. Key Message: The importance of cardiovascular risk factors and the pathogenic mechanisms related to inflammation in patients waitlisted for KT and kidney transplant recipients.

The Role of Race on Survival after Alternative Donor Hematopoietic Progenitor Cell Transplant for Pediatric Acute Leukemia: Provocative Single Center Data.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5323-5323
Author(s):  
David A. Margolis ◽  
Mary Eapen ◽  
Jeanette Carreras ◽  
Julie-An Talano ◽  
Meghen Browning ◽  
...  
Keyword(s):  
Risk Factors ◽  
African American ◽  
African Americans ◽  
Acute Leukemia ◽  
Children And Adolescents ◽  
Ethnic Groups ◽  
Hematopoietic Progenitor Cell ◽  
Unrelated Donor ◽  
Alternative Donor ◽  
Related Donor

Abstract Allogeneic blood or bone marrow transplant (BMT) can be a curative treatment for many children and adolescents with acute leukemia. With advances in unrelated donor transplant, others and we have shown that unrelated donor BMT can have similar survival to matched sibling BMT. There are several reports describing outcomes after matched related donor transplantation among various ethnic groups. Thus far, there are no published studies comparing outcomes among ethnic groups after alternative donor transplantation. Anecdotally, however, there have been concerns regarding outcomes among racial and ethnic groups, especially African-Americans. In order to address this question, we utilized our institutional database to analyze survival among children and adolescents receiving an alternative donor BMT at Children’s Hospital of Wisconsin from 1988-present. We compared survival in Caucasians and African-Americans undergoing unrelated donor and mismatched related donor transplantation (including haploidentical donors). One hundred and twenty four Caucasians underwent matched and mismatched unrelated donor transplantation compared to 11 African Americans. The 2-year probabilities of overall survival were significantly better for Caucasians at 53% (95% CI 44–62) than for African Americans, 18% (95% CI 2–45), p=0.01. Fifty-four Caucasians and 9 African Americans received mismatched family donor transplantation. Corresponding probabilities of overall 2-year survival were 38% (95% CI 25–51) and 30% (95% CI 5–64), respectively. Interestingly, our data show no statistically significant difference in survival after mismatched related donor transplantation between the Caucasian and African-American cohorts. Our data should be interpreted cautiously as the number of African Americans transplanted at our institution is few. Additionally, our analysis is limited by our inability to adjust for disease status at transplantation, HLA disparity and other known risk factors that may impact survival. Nevertheless these observations from a single institution cannot be ignored and warrant further analysis in a larger cohort such that outcomes after transplantation may be adjusted appropriately for relevant risk factors. We believe that a national database/registry study will have the numbers necessary to answer the questions that need to be asked regarding outcomes with alternative donor transplantation in the African-American population. We also believe that as cell processing and supportive care technologies improve mismatched family member transplantation outcomes, these advances could have a significant impact in improving leukemia-free survival for African-American children and adolescents.

THE ROLE OF FBROBLAST GROWTH FACTOR 23 (FGF 23) IN THE MINERAL AND BONE DISORDER (MBD) OF THE PATENTS WITH CHRONIC KIDNEY DISEASE

2016 ◽  
pp. 9-14
Author(s):  
Huu Vu Quang Nguyen ◽  
Tam Vo
Keyword(s):  
Chronic Kidney Disease ◽  
Growth Factor ◽  
Kidney Disease ◽  
Kidney Function ◽  
Mineral Metabolism ◽  
Fibroblast Growth Factor 23 ◽  
Normal Kidney ◽  
Mineral And Bone Disorder ◽  
Normal Kidney Function ◽  
Fgf 23

Fibroblast growth factor 23 (FGF23) is a key regulator of phosphorus metabolism whose effects in patients with chronic kidney disease (CKD) have only recently begun to be appreciated. Recent study of this phosphaturic hormone has revealed new path-ways of mineral regulation in both individuals with normal kidney function and in patients with CKD. While the effects of FGF23 on mineral metabolism in CKD appears to be similar to its effects in individuals with normal kidney function, elevated levels of the protein in the CKD population have also been linked to kidney disease progression, altered skeletal histology, and increased mortality rates, relationships that have not been examined in the general population.Thus, potential differences in FGF23 metabolism accompany the elevated levels found in CKD patients and, although the exact pathophysiological consequences remain mostly unknown, elevated FGF23 levels appear to contribute to major complications of CKD that plague both adults and children. Key words: FGF23, chronic kidney

The intersection of Mineralocorticoid Receptor (MR) activation and the FGF23 – Klotho cascade. A Duopoly that promotes renal and cardiovascular injury

2021 ◽  
Author(s):  
Murray Epstein ◽  
Michael Freundlich
Keyword(s):  
Risk Factors ◽  
Mineralocorticoid Receptor ◽  
Mineral Metabolism ◽  
Fibroblast Growth Factor 23 ◽  
Adverse Outcomes ◽  
Phosphate Metabolism ◽  
Fibroblast Growth ◽  
Fibrosis Progression ◽  
Circulating Levels ◽  
Functional Deterioration

Abstract The nexus of CKD and cardiovascular disease (CVD) amplifies the morbidity and mortality of CKD, emphasizing the need for defining and establishing therapeutic initiatives to modify and abrogate the progression of CKD and concomitant CV risks. In addition to the traditional CV risk factors, disturbances of mineral metabolism are specific risk factors that contribute to the excessive CV mortality in patients with CKD. These risk factors include dysregulations of circulating factors that modulate phosphate metabolism including fibroblast growth factor 23 (FGF23) and soluble Klotho. Reduced circulating levels and suppressed renal klotho expression may be associated with adverse outcomes in CKD patients. While elevated circulating concentrations or locally produced FGF23 in the strained heart exert pro-hypertrophic mechanisms on the myocardium, Klotho attenuates tissue fibrosis, progression of CKD, cardiomyopathy, endothelial dysfunction, vascular stiffness, and vascular calcification. Mineralocorticoid receptor (MR) activation in non-classical targets, mediated by aldosterone and other ligands, amplifies CVD in CKD. In concert, we detail how the interplay of elevated FGF23, activation of the MR, and concomitant reductions of circulating Klotho in CKD, may potentiate each other’s deleterious effects on kidney and the heart, thereby contributing to the initiation and progression of kidney and cardiac functional deterioration, acting through multipronged albeit complementary mechanistic pathways.

Abstract 08: Heterogeneity in Cardiovascular Disease Risk Factor Prevalence Among Whites, African Americans, African Immigrants and Afro-Caribbeans: Insights From the 2010-2018 National Health Interview Survey

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Diana Baptiste ◽  
Ruth-Alma N Turkson-Ocran ◽  
Oluwabunmi Ogungbe ◽  
Binu Koirala ◽  
Lucine Francis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
African Americans ◽  
Ethnic Groups ◽  
National Health ◽  
National Health Interview Survey ◽  
African Immigrants ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Interview Survey

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the U.S. Blacks are disproportionately affected by CVD risk factors, compared to whites. However, Blacks are not monolithic and include the following ethnic groups; African Americans (AAs), African Immigrants (AIs), and Afro-Caribbeans (ACs). It is unclear how AIs and ACs compare to their AA counterparts and Whites with respect to CVD risk factors. Objective: To examine trends in CVD risk factors among three Black ethnic groups in comparison to whites between 2010-2018. Methods: A comparative analysis of the National Health Interview Survey was conducted among N=452,997 participants, examining sociodemographic data and trends in self-reported CVD risk factors (hypertension, diabetes, overweight/obesity, and smoking). Generalized linear models with a Poisson distribution were used to obtain the respective predictive probabilities of CVD risk factors. Results: The sample included 82,835 Blacks (89% AAs, 5% AIs and 6% ACs) and 370,362 whites. AIs were the youngest with mean age of 40.8 years and were less likely to be insured (76%) compared to whites (91%) and AAs (83%) ( p =<0.001). ACs (23%) were more likely be college-educated than AAs (17%) but not AIs (36%) or whites (32%), (p=<0.001). AIs had the lowest age- and sex-adjusted prevalence of all four CVD risk factors. There were disparities (among AAs) and advantages (among AIs and ACs) in CVD risk factors. ( Figure) . Overweight/obesity and diabetes prevalence was increasing in AAs and whites ( p -values for trend<0.001). Smoking prevalence was highest in whites and AAs compared to AIs and ACs but the prevalence decreased significantly between 2010-2018 ( p -values for trend<0.001). Conclusion: Our results have shown significant heterogeneity in CVD risk factors among three Black ethnic groups compared to whites. These findings suggest that race alone does not account for health disparities in CVD risk factors. Environmental, psychological, and social factors may play a larger role in CVD risk.

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