Association of Serum Phosphorus With Left Ventricular Mass in Men and Women With Stable Cardiovascular Disease: Data From the Heart and Soul Study

Saab, Georges; Whooley, Mary A.; Schiller, Nelson B.; Ix, Joachim H.

doi:10.1053/j.ajkd.2010.03.030

« Previous Next »American Journal of Kidney Diseases
Volume 56, Issue 3 , Pages 496-505, September 2010

Association of Serum Phosphorus With Left Ventricular Mass in Men and Women With Stable Cardiovascular Disease: Data From the Heart and Soul Study

Georges Saab, MD
- Harry S. Truman Veterans Affairs Hospital, Columbia, MO
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
Mary A. Whooley, MD
- Department of Medicine, University of California San Francisco, San Francisco, CA
- General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA
Nelson B. Schiller, MD
- Department of Medicine, University of California San Francisco, San Francisco, CA
Joachim H. Ix, MD, MAS
- Division of Nephrology, Department of Medicine, University of California San Diego, San Diego, CA
- Nephrology Section, Veterans Affairs San Diego Healthcare System, University of California San Diego, San Diego, CA
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA
- Address correspondence to Joachim H. Ix, MD, MAS, Division of Nephrology, Department of Medicine, University of California San Diego, and San Diego VA Healthcare System, 3350 La Jolla Village Dr, Mail Code 9111-H, San Diego, CA 92161

Received 22 December 2009; accepted 24 March 2010. published online 28 June 2010.

Background

Higher serum phosphorus levels are associated with cardiovascular disease (CVD) events in the general population, an association that may be stronger in men. Estradiol has phosphaturic properties. Whether higher serum phosphorus levels are associated with left ventricular (LV) mass in persons without end-stage renal disease and whether the association is modified by sex is unknown.

Study Design

Cross-sectional observational study.

Setting & Participants

978 outpatients with stable CVD.

Predictor

The primary predictor variable was serum phosphorus level. Sex was evaluated as an effect modifier.

Outcome & Measurements

LV mass using transthoracic echocardiography.

Results

The association of serum phosphorus level with LV mass differed by sex (interaction P = 0.04). In models adjusted for age, race, kidney function, smoking, diabetes, blood pressure, cholesterol level, C-reactive protein level, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, each 1-mg/dL higher serum phosphorus level was associated with 4.52-g/m² greater LV mass (95% CI, 1.04-8.01; P = 0.01) in men. Conversely, in women, no statistically significant association was found between serum phosphorus level and LV mass.

Limitations

Older adult population with stable CVD; 19% were women.

Conclusions

In outpatients with stable CVD, higher serum phosphorus levels are associated with greater LV mass in men, but not women. Whether sex hormones may account for these differences requires future study.

Index Words: Sex hormones, phosphorus, cardiovascular disease, kidney dysfunction