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Fibroblast growth factor 23, left ventricular mass, and left ventricular hypertrophy in community-dwelling older
Anna Jovanovich1, Joachim H Ix, John Gottdiener
1Division of Renal Diseases and Hypertension, University of Colorado Denver, Mail Stop C281, 12700 E. 19th Ave, Room 7C03-A, Aurora, CO 80045, USA.
Insights
Higher FGF23 levels are linked to increased left ventricular mass and hypertrophy, especially in individuals with chronic kidney disease (CKD). This highlights FGF23 as a potential biomarker for cardiovascular risk in aging populations with kidney impairment.
Area of Science:
- Cardiovascular Research
- Nephrology
- Endocrinology
Background:
- Elevated Fibroblast Growth Factor 23 (FGF23) is linked to adverse cardiovascular outcomes and mortality in chronic kidney disease (CKD).
- The specific relationship between FGF23, left ventricular mass (LVM), and left ventricular hypertrophy (LVH) in the general population, and the modifying effect of CKD, remain incompletely understood.
Purpose of the Study:
- To investigate the association between plasma FGF23 concentrations and LVM/LVH in older adults.
- To determine if chronic kidney disease influences the relationship between FGF23 and cardiac structure/geometry.
Main Methods:
- C-terminal plasma FGF23 levels were measured in 2255 older adults (≥65 years) from the Cardiovascular Health Study.
- Left ventricular mass (LVM) and left ventricular hypertrophy (LVH) were assessed using echocardiography.
- Linear and logistic regression analyses, stratified by CKD status, were employed to examine associations, adjusting for relevant risk factors.
Main Results:
- Higher FGF23 concentrations were significantly associated with greater LVM across the entire cohort.
- These associations were notably stronger in participants with CKD compared to those without CKD (p-interaction = 0.006).
- While the interaction for LVH was not statistically significant, the odds ratio for LVH was higher in the CKD group.
Conclusions:
- In older community-dwelling adults, elevated FGF23 levels are associated with increased LVM and LVH.
- The relationship between FGF23 and cardiac remodeling is amplified in the presence of CKD, suggesting a critical role in cardiovascular risk stratification.
Objectives:
In chronic kidney disease (CKD), high FGF23 concentrations are associated with left ventricular hypertrophy (LVH), cardiovascular events, and death. The associations of FGF23 with left ventricular mass (LVM) and LVH in the general population and the influence of CKD remains uncertain.
Methods:
C-terminal plasma FGF23 concentrations were measured, and LVM and LVH evaluated by echocardiogram among 2255 individuals ≥65 years in the Cardiovascular Health Study. Linear regression analysis adjusting for demographics, cardiovascular, and kidney related risk factors examined the associations of FGF23 concentrations with LVM. Analyses were stratified by CKD status and adjusted linear and logistic regression analysis explored the associations of FGF23 with LVM and LVH.
Results:
Among the entire cohort, higher FGF23 concentrations were associated with greater LVM in adjusted analyses (β = 6.71 [95% CI 4.35-9.01] g per doubling of FGF23). 32% (n = 624) had CKD (eGFR <60 mL/min/1.73 m(2) and/or urine albumin-to-creatinine ratio >30 mg/g). Associations were stronger among participants with CKD (p interaction = 0.006): LVM β = 9.71 [95% CI 5.86-13.56] g per doubling of FGF23 compared to those without CKD (β = 3.44 [95% CI 0.77, 6.11] g per doubling of FGF23). While there was no significant interaction between FGF23 and CKD for LVH (p interaction = 0.25), the OR (1.46 95% CI [1.20-1.77]) in the CKD group was statistically significant and of larger magnitude than the OR for in the no CKD group (1.12 [95% CI 0.97-1.48]).
Conclusion:
In a large cohort of older community-dwelling adults, higher FGF23 concentrations were associated with greater LVM and LVH with stronger relationships in participants with CKD.
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