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Titolo	Relations of Serum Phosphorus and Calcium to the Incidence of Cardiovascular Disease in the Community
Autore	R. Dhingra, L.M. Sullivan, C.S. Fox, T.J. Wang, R.B. D?Agostino, J.M. Gaziano, R.S. Vasan
Referenza	Arch Intern Med 2007; 167: 879-885
Contenuto	Background: Higher levels of serum phosphorus and the calcium-phosphorus product are associated with increased mortality from cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) or prior CVD. However, it is unknown if serum phosphorus levels influence vascular risk in individuals without CKD or CVD. Methods: We prospectively evaluated 3368 Framingham Offspring study participants (mean age, 44 years; 51% were women) free of CVD and CKD. We used multivariable Cox models to relate serum phosphorus and calcium levels to CVD incidence. Results: Onfollow-up (mean duration, 16.1 years), there were 524 incident CVD events (159 in women). In multivariable analyses and adjusting for established risk factors andadditionally for glomerular filtration rateandforhemoglobin, serum albumin, proteinuria, and C-reactive protein levels, a higher level of serum phosphorus was associated withanincreasedCVDrisk inacontinuousfashion(adjusted hazard ratio per increment of milligrams per deciliter, 1.31; 95%confidence interval, 1.05-1.63;P=.02;Pvalue for trend acrossquartiles=.004).Individualsinthehighestserumphosphorus quartile experienced a multivariable-adjusted 1.55- fold CVD risk (95% confidence interval, 1.16%-2.07%; P=.004) compared with those in the lowest quartile. These findingsremainedrobustintime-dependentmodelsthatupdatedCVDrisk factorsevery4yearsandinanalysesrestricted to individuals without proteinuriaandanestimated glomerular filtration rate greater than 90 mL/min per 1.73 m2. Serum calcium was not related to CVD risk. Conclusion: Higher serum phosphorus levels are associated with an increased CVD risk in individuals free of CKDandCVDin the community. These observations emphasize the need for additional research to elucidate the potential link between phosphorus homeostasis and vascular risk.
Data	13.06.2007

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