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J Clin Endocrinol Metab. 2019 Nov 24. pii: dgz218. doi: 10.1210/clinem/dgz218. [Epub ahead of print]

Impact of race on the association of mineral metabolism with heart failure: the Multi-Ethnic Study of Atherosclerosis.

Author information

Vanderbilt O'Brien Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA.
Division of Nephrology, Tufts Medical Center, Boston, MA.
Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
Cricket Health, Inc., San Francisco, CA.
Department of Laboratory Medicine, University of Washington, Seattle, WA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of Nephrology, Department of Medicine, University of California, San Diego, CA.
Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA.



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/ethnic groups. In this study, we evaluated whether the associations of mineral metabolism markers with HF differed by race/ethnicity.


We included participants free of cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis to quantify rates of HF overall and across race/ethnic groups. Using Cox models, we tested associations of baseline higher phosphorus (>4mg/dL), PTH >65 pg/ml and FGF-23 >46.5 pg/ml with incident HF, and for interactions by race/ethnicity, adjusting for sociodemographic and cardiovascular risk factors.


Among the 6,413 participants, median follow-up time was 14.9 years. The incidence rate for HF was highest for Blacks and lowest for Chinese (4.71 and 2.42 per 1000 py, respectively). The prevalence of elevated PTH (18.8% vs. 7.4%) but not FGF-23 (23.1% vs. 28.8%) were higher in Blacks vs. Caucasians. In multivariable models, the associations of elevated PTH (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/ethnicity were not statistically significant.


In a multi-ethnic population, higher PTH and FGF23 were associated with the risk of HF in black and Hispanic individuals. There is no evidence that race/ethnicity modifies the association of altered mineral metabolism with risk of HF.


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