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Alkaline phosphatase, serum phosphate, and incident cardiovascular disease and total mortality in older men

Sasiwarang Goya Wannamethee1, Naveed Sattar, Olia Papcosta

  • 1Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, Rowland Hill St, London NW3 2PF, United Kingdom. g.wannamethee@ucl.ac.uk

Arteriosclerosis, Thrombosis, and Vascular Biology
|February 23, 2013
PubMed

Insights

Alkaline phosphatase (ALP) and serum phosphate are linked to increased total mortality in older men. While ALP predicts coronary heart disease risk, serum phosphate is associated with non-coronary cardiovascular disease mortality.

Area of Science:

  • Biochemistry
  • Cardiology
  • Gerontology

Background:

  • Cardiovascular disease (CVD) remains a leading cause of mortality in older adults.
  • Serum phosphate and alkaline phosphatase (ALP) are common biomarkers, but their independent associations with CVD outcomes and mortality require further investigation.
  • Understanding these associations can inform risk stratification and preventive strategies in elderly populations.

Purpose of the Study:

  • To investigate the association between serum phosphate and alkaline phosphatase (ALP) levels and incident cardiovascular disease (CVD) outcomes.
  • To examine the relationship between serum phosphate and ALP with total mortality in older men.
  • To determine if these associations persist after adjusting for known CVD risk factors and excluding individuals with chronic kidney disease.

Main Methods:

  • Prospective cohort study involving 3381 men aged 60-79 years without prior myocardial infarction or stroke.
  • Follow-up averaged 11 years, during which major CVD events and total deaths were recorded.
  • Statistical analyses included Cox proportional hazards models, adjusting for CVD risk factors, inflammation markers, and subgroup analyses excluding chronic kidney disease.

Main Results:

  • Alkaline phosphatase (ALP), but not serum phosphate, was significantly associated with increased risk of coronary heart disease and overall CVD events.
  • Serum phosphate showed an association with increased CVD mortality, specifically from non-coronary heart disease or stroke causes.
  • Both elevated ALP and serum phosphate levels were independently associated with significantly increased total mortality in older men, even after comprehensive adjustments.

Conclusions:

  • Alkaline phosphatase (ALP) is a significant predictor of coronary heart disease risk in elderly men.
  • Serum phosphate is associated with specific CVD mortality pathways, distinct from coronary events.
  • Both high ALP and serum phosphate levels represent important risk factors for all-cause mortality in older men, highlighting their clinical relevance.
Abstract

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