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Association between blood phosphorus level and adverse outcomes in patients with coronary artery disease: A
Luyu Zhu1, Ziyan Liu2, Shiqi Zhang1
1Department of Gastroenterology, The Suqian Clinical College of Xuzhou Medical University, Suqian, Jiangsu, China, 223800.
Insights
High blood phosphorus levels (hyperphosphatemia) significantly increase mortality risk in coronary artery disease (CAD) patients. Low phosphorus levels (hypophosphatemia) did not show a significant association with adverse outcomes in this patient group.
Area of Science:
- Cardiology
- Clinical Biochemistry
- Epidemiology
Background:
- The prognostic significance of serum phosphorus levels in patients with coronary artery disease (CAD) is not well-established.
- Existing research presents conflicting findings regarding the association between phosphorus levels and adverse outcomes in CAD patients.
Purpose of the Study:
- To conduct a meta-analysis evaluating the prognostic role of blood phosphorus levels in patients diagnosed with coronary artery disease (CAD).
Main Methods:
- A systematic literature search was performed across PubMed, Web of Science, Scopus, and Embase databases until December 2023.
- Included studies were longitudinal observational studies (prospective or retrospective) examining blood phosphorus levels and outcomes in CAD patients.
- Outcome measures comprised all-cause mortality, cardiovascular mortality, heart failure, stroke, and major adverse cardiac events (MACEs). Pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated.
Main Results:
- Six studies with 19,553 CAD patients were analyzed.
- Hyperphosphatemia was significantly associated with increased risks of all-cause mortality (HR 1.39; 95% CI 1.20-1.61), cardiovascular mortality (HR 1.37; 95% CI 1.22-1.53), heart failure (HR 1.64; 95% CI 1.44-1.87), and MACEs (HR 1.39; 95% CI 1.03-1.88).
- No significant association was found between hypophosphatemia and any of the studied outcomes.
Conclusions:
- Hyperphosphatemia is an independent predictor of adverse outcomes, including mortality and heart failure, in patients with coronary artery disease (CAD).
- Hypophosphatemia does not appear to be a significant prognostic factor for adverse events in CAD patients.
Objective:
The prognostic implication of phosphorus level in patients with coronary artery disease (CAD) remains controversial. We aimed to conduct a meta-analysis to evaluate the prognostic role of blood phosphorus level in CAD patients.
Methods:
We searched the PubMed, Web of Science, Scopus, and Embase databases until December 28, 2023, to identify prospective or retrospective longitudinal observational studies that examined the prognostic value of blood phosphorus level in CAD patients. Outcome measures included all-cause or cardiovascular mortality, heart failure, stroke, and major adverse cardiac events (MACEs). The prognostic value of blood phosphorus level was expressed by pooling the fully adjusted hazard ratios (HR) with 95 % confidence intervals (CI) for the hypophosphatemia or hyperphosphatemia compared to the reference normal phosphorus level.
Results:
Six studies involving 19,553 CAD patients were included. Meta-analysis showed that the hyperphosphatemia was significantly associated with higher risk of all-cause mortality (HR 1.39; 95 % CI 1.20-1.61), cardiovascular mortality (HR 1.37; 95 % CI 1.22-1.53), heart failure (HR 1.64; 95 % CI 1.44-1.87), and MACEs (HR 1.39; 95 % CI 1.03-1.88) but not stroke (HR 1.23; 95 % CI 0.79-1.92). However, non-significant association was found between hypophosphatemia and all-cause mortality (HR 1.21; 95 % CI 0.98-1.51), cardiovascular mortality (HR 1.07; 95 % CI 0.78-1.45), heart failure (HR 0.87; 95 % CI 0.72-1.05), stroke (HR 1.12; 95 % CI 0.76-1.67), and MACEs (HR 1.16; 95 % CI 0.99-1.36).
Conclusions:
Hyperphosphatemia, but not hypophosphatemia independently predicts all-cause mortality, cardiovascular mortality, heart failure, and MACEs in CAD patients.
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