Urinary Phosphate and Subclinical Atherosclerosis: The AWHS Study

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Public Health

Background:

• Atherosclerosis is a primary cause of global vascular mortality.
• Elevated urinary phosphate is a suspected cardiovascular risk factor, but its precise role requires further elucidation.
• Understanding the link between phosphate and atherosclerosis is crucial for cardiovascular disease prevention strategies.

Purpose of the Study:

• To investigate the association between urinary phosphate levels and subclinical atherosclerosis.
• To examine atherosclerosis in the carotid, femoral, and coronary arteries.
• To assess the role of urinary phosphate as a potential cardiovascular risk marker.

Main Methods:

• Cross-sectional analysis of 1169 middle-aged men from the Aragon Workers Health Study (AWHS).
• Urinary phosphate quantification using the Fiske-Subbarow method.
• Assessment of carotid and femoral plaque via ultrasound; coronary artery calcium score (CACS) via computed tomography.
• Logistic regression models to determine adjusted prevalence of atherosclerosis.

Main Results:

• A significant inverse association was found between urinary phosphate and subclinical carotid atherosclerosis (OR 0.69 [0.49-0.99]).
• Higher urinary phosphate correlated with lower prevalence of severe coronary atherosclerosis (CACS > 200) (OR 0.46 [0.23-0.88]).
• No significant association was observed between urinary phosphate and femoral atherosclerosis (OR 1.02 [0.72-1.45]).

Conclusions:

• Increased urinary phosphate concentration is associated with reduced prevalence of subclinical carotid and coronary atherosclerosis in middle-aged men.
• Urinary phosphate may play a protective role against atherosclerosis in specific vascular territories.
• Further research is warranted to confirm these findings and explore underlying mechanisms.