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Serum phosphate levels are related to all-cause, cardiovascular and COPD mortality in men

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Abstract
Hyperphosphatemia has been associated with increased mortality in chronic kidney disease but the nature of such a relation in the general population is unclear. To investigate the association between phosphate (P) levels and all-cause and cause-specific mortality, we assessed two cohorts from the Rotterdam Study, with follow-up of 14.5 (RS-I) and 10.9 (RS-II) years until January 2012 with availability of fasting phosphate levels. Deaths were classified according to International Classification of Diseases into 7 groups: cardiovascular, cancer, infections, external, dementia, chronic lung diseases and other causes. Sex-stratified Weibull and competing-risks models were adjusted for age, BMI and smoking. Hazard ratios are expressed per 1 mg/dL increase in phosphate levels. The total number of participants included 3731 (RS-I, 2154 women) and 2494 (RS-II, 1361 women) subjects. The main outcome measures were all-cause and cause-specific mortality. A significant positive association was found between phosphate and all-cause mortality in men (pooled HR (95% CI): 1.46 (1.26-1.69)) but not in women (0.90 (0.77-1.05)). In men, higher phosphate increased the risk for cardiovascular mortality (1.66 (1.29-2.14)), other causes (1.67 (1.16-2.40)) and chronic lung disease mortality (1.94 (1.02-3.72)), the latter driven by mortality due to chronic obstructive pulmonary disease (COPD) (4.44 (2.08-9.49)). No relations were found for mortality due to infections, cancer, dementia or external causes. In conclusion, serum P is associated with increased all-cause, cardiovascular and COPD mortality in men but not women. The association with COPD mortality is novel and needs further research on underlying mechanisms.
Keywords
COPD, Emphysema, Mortality, Phosphate, Phosphotoxicity, GROWTH-FACTOR 23, CHRONIC KIDNEY-DISEASE, OBSTRUCTIVE PULMONARY-DISEASE, PARATHYROID-HORMONE, VITAMIN-D, VASCULAR CALCIFICATION, ARTERY CALCIFICATION, DIETARY PHOSPHORUS, MINERAL METABOLISM, KLOTHO DEFICIENCY

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Chicago
Campos-Obando, Natalia, Lies Lahousse, Guy Brusselle, Bruno H Stricker, Albert Hofman, Oscar H Franco, André G Uitterlinden, and M Carola Zillikens. 2018. “Serum Phosphate Levels Are Related to All-cause, Cardiovascular and COPD Mortality in Men.” European Journal of Epidemiology 33 (9): 859–871.
APA
Campos-Obando, N., Lahousse, L., Brusselle, G., Stricker, B. H., Hofman, A., Franco, O. H., Uitterlinden, A. G., et al. (2018). Serum phosphate levels are related to all-cause, cardiovascular and COPD mortality in men. EUROPEAN JOURNAL OF EPIDEMIOLOGY, 33(9), 859–871.
Vancouver
1.
Campos-Obando N, Lahousse L, Brusselle G, Stricker BH, Hofman A, Franco OH, et al. Serum phosphate levels are related to all-cause, cardiovascular and COPD mortality in men. EUROPEAN JOURNAL OF EPIDEMIOLOGY. 2018;33(9):859–71.
MLA
Campos-Obando, Natalia, Lies Lahousse, Guy Brusselle, et al. “Serum Phosphate Levels Are Related to All-cause, Cardiovascular and COPD Mortality in Men.” EUROPEAN JOURNAL OF EPIDEMIOLOGY 33.9 (2018): 859–871. Print.
@article{8574532,
  abstract     = {Hyperphosphatemia has been associated with increased mortality in chronic kidney disease but the nature of such a relation in the general population is unclear. To investigate the association between phosphate (P) levels and all-cause and cause-specific mortality, we assessed two cohorts from the Rotterdam Study, with follow-up of 14.5 (RS-I) and 10.9 (RS-II) years until January 2012 with availability of fasting phosphate levels. Deaths were classified according to International Classification of Diseases into 7 groups: cardiovascular, cancer, infections, external, dementia, chronic lung diseases and other causes. Sex-stratified Weibull and competing-risks models were adjusted for age, BMI and smoking. Hazard ratios are expressed per 1 mg/dL increase in phosphate levels. The total number of participants included 3731 (RS-I, 2154 women) and 2494 (RS-II, 1361 women) subjects. The main outcome measures were all-cause and cause-specific mortality. A significant positive association was found between phosphate and all-cause mortality in men (pooled HR (95% CI): 1.46 (1.26-1.69)) but not in women (0.90 (0.77-1.05)). In men, higher phosphate increased the risk for cardiovascular mortality (1.66 (1.29-2.14)), other causes (1.67 (1.16-2.40)) and chronic lung disease mortality (1.94 (1.02-3.72)), the latter driven by mortality due to chronic obstructive pulmonary disease (COPD) (4.44 (2.08-9.49)). No relations were found for mortality due to infections, cancer, dementia or external causes. In conclusion, serum P is associated with increased all-cause, cardiovascular and COPD mortality in men but not women. The association with COPD mortality is novel and needs further research on underlying mechanisms.},
  author       = {Campos-Obando, Natalia and Lahousse, Lies and Brusselle, Guy and Stricker, Bruno H and Hofman, Albert and Franco, Oscar H and Uitterlinden, André G and Zillikens, M Carola},
  issn         = {0393-2990},
  journal      = {EUROPEAN JOURNAL OF EPIDEMIOLOGY},
  keywords     = {COPD,Emphysema,Mortality,Phosphate,Phosphotoxicity,GROWTH-FACTOR 23,CHRONIC KIDNEY-DISEASE,OBSTRUCTIVE PULMONARY-DISEASE,PARATHYROID-HORMONE,VITAMIN-D,VASCULAR CALCIFICATION,ARTERY CALCIFICATION,DIETARY PHOSPHORUS,MINERAL METABOLISM,KLOTHO DEFICIENCY},
  language     = {eng},
  number       = {9},
  pages        = {859--871},
  title        = {Serum phosphate levels are related to all-cause, cardiovascular and COPD mortality in men},
  url          = {http://dx.doi.org/10.1007/s10654-018-0407-7},
  volume       = {33},
  year         = {2018},
}

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