how does phosphorus affect the heart

We determined that the proportional-hazard assumption was satisfied by examining plots of the log-negative-log of the within-group survivorship functions versus log-time and by comparing Kaplan-Meier (observed) with Cox (expected) survival curves. Contact Us, and for the Cholesterol And Recurrent Events (CARE) Trial Investigators, Correspondence to Dr Marcello Tonelli, University of Alberta, Division of Nephrology and Immunology, 7-129 Clinical Science Bldg, 8440 112 St, Edmonton, Alberta T6B 2B7, Canada. Given the ready availability and low cost of serum phosphate assays, this finding may prove clinically useful. For example, mean GFR was 68.2 mL/min/1.73 m2 in subjects with serum phosphate <2.5 mg/dL and 72.8 mL/min/1.73 m2 in those with serum phosphate ≥4 mg/dL. This post hoc analysis of data from a previously conducted randomized trial was approved by the institutional review board at the University of Alberta. Low blood phosphorus, or hypophosphatemia, can also be dangerous. A graded association was noted between baseline level of serum phosphate and the adjusted risk of all-cause mortality, development of heart failure or fatal or nonfatal myocardial infarction, and the composite outcome of fatal coronary disease or nonfatal myocardial infarction (all P for trend=0.03; Figure 1 and Figure 2). High levels of phosphorus in the blood can cause: bone and heart problems that lead to hospital stays and in some cases death too much PTH to be released, which over time can weaken bones and make them more likely to break and develop renal osteodystrophy low blood calcium, which causes calcium to be taken from the bones Many enzymes and hormones depend on phosphates for their activation, and your body needs them to maintain a normal acidity. Having too much phosphorus in your blood is also called hyperphosphatemia. The American Heart Association is qualified 501(c)(3) tax-exempt Finally, we forced additional variables that could conceivably be associated with either exposure or outcome (baseline diuretic use, pravastatin use, serum calcium, and proteinuria) into the adjusted model; they did not appreciably affect results (data not shown). Phosphorus metabolism is tightly bound to that of calcium – both minerals are affected by the same hormones, usually in the opposite direction. It also helps your muscles to move, your nerves to work, and your kidneys to filter blood. The relation between the baseline calcium-phosphate ion product and adverse clinical outcomes was tested by inserting a cross-product interaction term into the Cox models. Phosphorus is not removed very well in dialysis because it is a big molecule. To remain within that range, your body can excrete excess phosphorus in the urine or use it for bone formation. Occasionally, however, high levels of potassiu… The University of Maryland Medical Center estimates that approximately 85 percent of the body's phosphorus occurs in bones and teeth, alongside calcium. Curves show the survivor function for each stratum of baseline serum phosphate using the mean of covariates method. We tested the hypothesis that higher serum phosphate levels were associated with risk of all-cause mortality and adverse cardiovascular outcomes in a population of participants with coronary disease, the vast majority of whom did not have overt hyperphosphatemia. Several recent studies demonstrate that higher levels of phosphate are associated with an increased risk of all-cause and cardiovascular death when kidney function is impaired, especially in people with end-stage renal disease.6–9 Vascular calcification has been postulated as the link between hyperphosphatemia and adverse outcomes in the setting of kidney disease, perhaps accelerated by abnormal calcium levels and hyperparathyroidism.5,16 However, unlike participants in the present trial (only 5.2% of whom had hyperphosphatemia at baseline), many of the subjects in these previous studies had overt hyperphosphatemia or were receiving medications that may have influenced the association between serum phosphate and outcome. 142, Issue Suppl_4, November 17, 2020: Vol. The levels of … A high level of phosphorus in the blood can cause weak and brittle bones, bone pain and itching. Breathing white phosphorus for long periods may cause a condition known as “phossy jaw” which involves poor wound healing of the mouth and breakdown of the jaw bone. A significant association was noted between baseline serum phosphate level and the age-, race-, and sex-adjusted risk of all-cause death (hazard ratio per 1 mg/dL, 1.27; 95% confidence interval, 1.02 to 1.58). To keep your heart healthy, the amount of salt you ingest may be restricted to 1500 mg (1.5 g) per day. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. Chronic hypophosphatemia In chronic hypophosphatemia, the phosphate level in blood becomes low over time. Normal range is 3.7 to 5.2 mEq/L (3.7 to 5.2 mmol/L). Your heart and lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing. After stratification according to clinical center, eligible and consenting participants were assigned by computer-generated random order in a double-blinded fashion to receive either 40 mg pravastatin (Pravachol, Bristol-Myers Squibb) once daily or placebo. TABLE 3. The potential mechanism for the association between serum phosphate levels and adverse outcomes in the present study is unclear. Medicines that interact with hydralazine may either decrease its effect, affect how long … Imbalances may disrupt your metabolism and raise your risk of chronic diseases. HRs have been adjusted for age, sex, race, smoking status, diabetic status, waist-to-hip circumference ratio, fasting glucose, GFR, hemoglobin, serum albumin, aspirin use, and left ventricular ejection fraction (all at baseline). This enzyme is involved in the production of angiotensin II, a powerful vasoconstrictor (a substance that narrows the arteries), which also stimulates the release of the hormone, aldosterone, from the adrenal glands (aldosterone increases blood pressure). Factors that were independently associated with serum phosphate level are shown in Table 2. Phosphorus' mere involvement in all energy production makes it an indispensable partner to your heart since, like all organs, your heart needs energy in order to function. Also, high phosphorus can cause calcium to settle inside the blood vessels. Although we did not have data on parathyroid hormone levels, we controlled for estimated GFR and for other factors that might be associated with hyperparathyroidism such as serum calcium and albumin. After full adjustment, higher levels of baseline serum phosphate were significantly associated with the composite outcome of fatal or nonfatal myocardial infarction (P for trend=0.03). However, our study also has some limitations that should be considered. Poor balance of minerals like calcium and phosphorus leading to disease and heart problems Each one of these conditions forces your heart to work harder. The kidneys, bones, and intestines regulate phosphorus homeostasis, which requires maintenance of urinary losses at equivalent levels to net phosphorus absorption and ensuring that equal amounts of phosphorus are deposited and resorbed from bone [1,7,8]. Potassium is an essential mineral, meaning that your body must obtain it from your diet. High phosphorus levels might also promote heart disease by triggering a hormone called parathyroid hormone, which puts the body in a state of inflammation. Phosphate supplements are considered safe if taken as prescribed. Further studies are required to determine the explanation for the association between phosphate and adverse clinical outcomes and to confirm that this relation is present in other populations. Eating or drinking small amounts of white phosphorus may cause liver, heart, or kidney damage, vomiting, stomach cramps, drowsiness, or death. 142, Issue 16_suppl_2, Basic, Translational, and Clinical Research, Arteriosclerosis, Thrombosis, and Vascular Biology, Journal of the American Heart Association, Relation Between Serum Phosphate Level and Cardiovascular Event Rate in People With Coronary Disease, Arterial Calcification in Diabetes Mellitus, Association Between Serum Phosphate Levels and Stroke Risk in Patients Undergoing Hemodialysis, Fibroblast Growth Factor 23 Is an Independent and Specific Predictor of Mortality in Patients With Heart Failure and Reduced Ejection Fraction, Serum Alkaline Phosphatase Negatively Affects Endothelium-Dependent Vasodilation in Naïve Hypertensive Patients, Processed and Unprocessed Red Meat Consumption and Risk of Heart Failure, Fibroblast Growth Factor‐23 and Incident Coronary Heart Disease, Heart Failure, and Cardiovascular Mortality: The Atherosclerosis Risk In Communities Study, Alkaline Phosphatase, Serum Phosphate, and Incident Cardiovascular Disease and Total Mortality in Older Men, Serum Alkaline Phosphatase and Phosphate in Cerebral Atherosclerosis and Functional Outcomes After Cerebral Infarction, Dietary Phosphate Modulates Atherogenesis and Insulin Resistance in Apolipoprotein E Knockout Mice—Brief Report, Arterial Calcification in Chronic Kidney Disease: Key Roles for Calcium and Phosphate, Vitamin D Deficiency Is Associated With Subclinical Carotid Atherosclerosis, Conjoint Effects of Serum Calcium and Phosphate on Risk of Total, Cardiovascular, and Noncardiovascular Mortality in the Community, Dietary Phosphorus, Blood Pressure, and Incidence of Hypertension in the Atherosclerosis Risk in Communities Study and the Multi-Ethnic Study of Atherosclerosis, Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Chronic Kidney Disease, Relation Between Alkaline Phosphatase, Serum Phosphate, and All-Cause or Cardiovascular Mortality, Global Impact of the 2017 ACC/AHA Hypertension Guidelines. Some of those functions involve your heart. Figure 2. Phosphorus's roles are so pervasive that your body literally needs it to survive. Higher levels of serum phosphate were associated with an increased risk of new heart failure after adjustment for age, sex, and race (P for trend=0.02; Table 3) and in the model (P for trend=0.03; Table 3). First, because this was a post hoc observational analysis, we cannot rule out the possibility of residual confounding. The small numbers of subjects with levels of serum phosphate in the lowest and highest categories probably contributed to the nonsignificant relation between serum phosphate (as a continuous variable) and outcome, because tests for trend were significant when phosphate was treated as a categorical variable. These characteristics were forced into the adjusted model presented above but did not appreciably affect the association between higher levels of serum phosphate and the increased risk of death (P for trend=0.047), new heart failure (P for trend=0.02), fatal or nonfatal myocardial infarction (P for trend=0.04), the composite of fatal coronary disease or nonfatal myocardial infarction (P for trend=0.04), or stroke (P for trend=0.33). Analyses were performed with Stata 8 SE software. If your kidneys don't work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death. Overall, there was a direct association between GFR and serum phosphate levels, but stratified analyses showed that serum phosphate was inversely correlated with kidney function when baseline GFR was <60 mL/min/1.73 m2 and directly correlated with kidney function when baseline GFR was ≥60 mL/min/1.73 m2. It can also regulate blood phosphorus levels by controlling its absorption from food and moving phosphorus-containing compounds in and out of cells. Given the biological importance of phosphorus, it is plausible that higher levels of serum phosphate within the normal range may also be associated with adverse outcomes. Values are reported as mean±SD or percentages; 95% confidence intervals (CIs) are provided when appropriate, and all probability values are 2 sided. Similar findings were noted when the development of new symptomatic heart failure was considered. Baseline serum phosphate levels were measured in 4127 fasting participants who were randomized to receive pravastatin 40 mg daily or placebo and followed up for a median of 59.7 months. 142, Issue Suppl_3, October 20, 2020: Vol. Strengths of our study include its relatively large size and the use of a central laboratory for all biochemical measurements. Over time this can lead to increased risk of heart attack, stroke or death. Background— Higher levels of serum phosphate are associated with adverse cardiovascular outcomes, especially in the setting of overt hyperphosphatemia. After categorization based on baseline phosphate level (<2.5, 2.5 to 3.4, 3.5 to 3.9, and ≥4 mg/dL) and further adjustment, a graded independent relation between phosphate and death was observed (P for trend=0.03). For instance, participants with serum phosphate ≥3.5 mg/dL had an adjusted hazard ratio for death of 1.27 (95% confidence interval, 1.02 to 1.59) compared with those with serum phosphate of <3.5 mg/dL. One of the most important organs in your body, a healthy heart helps you maintain an active lifestyle. The following reactions can occur: Body As A Whole: Ischemic injury due to potent vasoconstrictor action and tissue hypoxia. However, the hypothesis that serum phosphate levels would be associated with adverse outcomes was formulated before the analyses were started, reducing the risk of spurious conclusions. It can also result in death. Given the ready availability and low cost of serum phosphate assays, this finding may prove clinically useful. This sudden drop in phosphate level may result in an abnormal heart rhythm and even death. Second, this analysis concerns a select population of individuals with prior myocardial infarction who were eligible for a randomized trial and therefore may not be representative of the general population. Cardiovascular System: Bradycardia, probably as a reflex result of a rise in blood pressure, arrhythmias. Phosphorus is essential for multiple and diverse biological functions, including cellular signal transduction, mineral metabolism, and energy exchange. None: I am not aware of a direct effect by phosphorous on the heart although it has inverse relationship with calcium which have strong cardiac effect Answered on … Other blood tests may be … A raised level of FGF23 puts increased strain on the heart. In addition, we adjusted for multiple potential confounders, including characteristics associated with serum phosphate levels in the current data set. Several hormones, including estrogen and adrenaline, also affect phosphorus homeostasis. She holds a bachelor's degree in biological sciences from Goucher College and a MBA in healthcare management from the University of Baltimore. White phosphorus has been found in at least 77 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA). Background— Higher levels of serum phosphate are associated with adverse cardiovascular outcomes, especially in the setting of overt hyperphosphatemia. Participants with serum phosphate ≥4 mg/dL had a fully adjusted HR for experiencing the composite outcome of coronary death or nonfatal myocardial infarction of 1.32 (95% CI, 0.95 to 1.84) compared with those with serum phosphate of 2.5 to 3.4 mg/dL. Fully adjusted risk of clinical outcomes by baseline serum phosphate. Fatal coronary disease or nonfatal myocardial infarction. E-mail. We found a graded, independent association between baseline fasting serum phosphate level and the risk of all-cause death, development of new heart failure, and coronary events in this population of individuals with previous myocardial infarction, most of whom had serum phosphate levels within the normal range. Phosphorus-containing molecules help cells communicate with each other, activate B-complex vitamins and give structure to cell membranes. 7272 Greenville Ave. Second to calcium in terms of abundance, it is a component of every cell of your body, primarily in the phosphate form, and assists with multiple biological functions. By continuing to browse this site you are agreeing to our use of cookies. Healthy kidneys remove extra phosphorus from the blood. TABLE 1. Levels of 25-hydroxyvitamin D and calcitriol are reduced in heart failure, in association with increased serum phosphate but apparently normal serum calcium, after correction for serum albumin.18–20 This low vitamin D status is hypothesized to influence cardiac contractility through effects on intracellular calcium and phosphate levels20 and has been linked to a modest increase in the risk of myocardial infarction in the general population.21 Although CARE participants were free of symptomatic heart failure at baseline, we speculate that higher serum levels of phosphate might be a marker for low vitamin D status and subclinical myocardial dysfunction. Vitamins & Minerals That Affect the Heart. Although >80% of total body phosphorus is stored in bone and teeth, intracellular phosphorus exists in the form of organic compounds such as adenosine triphosphate and as free anions like H2PO4−, which are commonly referred to as phosphate. Breathing white phosphorus for long periods may cause a condition known as 'phossy jaw', which involves poor wound healing of the mouth and breakdown of the jaw bone. Your body regulates potassium closely in order to maintain normal function. In addition, mean serum phosphate levels were similar in people with and without baseline GFR <60 mL/min/1.73 m2 (3.3±0.5 versus 3.3±0.5 mg/dL; P>0.9). If you have too much phosphorus in your body for a long period of time, your chance of a heart attack or stroke goes up. We identified several characteristics that were significantly associated with higher serum phosphate levels, including female sex, black race, diabetic status, higher levels of serum albumin, lower levels of hemoglobin, and current smoking. Health Effects: Exposure to white phosphorus may cause liver, heart, or kidney damage. Customer Service Phosphorus is a mineral that is essential for human health. In sensitivity analyses, we adjusted for additional baseline factors found to be associated with serum phosphate levels in the current data set (alcohol use, country of treatment, use of β-adrenergic blockers, systolic blood pressure). Nervous System: Anxiety, transient headache. You may also obtain it from nuts, legumes and cereals. Probability values for trend are as follows: All-cause death, P=0.03; new congestive heart failure, P=0.03; fatal or nonfatal myocardial infarction, P=0.03; and coronary death or nonfatal myocardial infarction, P=0.03. White phosphorus is a waxy solid which burns easily and is used in chemical manufacturing and smoke munitions. HRs have been adjusted for age, sex, race, smoking status, diabetic status, waist-to-hip circumference ratio, fasting glucose, GFR, hemoglobin, serum albumin, aspirin use, and left ventricular ejection fraction (all at baseline). The primary outcome for this analysis was all-cause mortality. Our health depends on … Shortness of breath that comes on suddenly (called acute) has a limited number of causes, including: PDF | Objective The impact of phosphorus supplementation on athletic performance is unclear. Participants with serum phosphate ≥4 mg/dL had a fully adjusted HR for experiencing myocardial infarction of 1.50 (95% CI, 1.05 to 2.16) compared with those with serum phosphate of 2.5 to 3.4 mg/dL. The condition can affect the veins and arteries and is known as vascular calcification. Dr Tonelli was supported by a Population Health Investigator Award from Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research. As with other essential minerals, however, the key to health is balance. Cardiovascular Disease Hardening of arteries, called atherosclerosis, and calcification of the tissues in the heart due to excess phosphorus levels significantly … A very low potassium level can even cause your heart to stop. We used Cox proportional-hazards models to examine the association between serum phosphate and adverse clinical outcomes after adjustment for potential confounders. Further adjustment for factors independently associated with mortality using stepwise multivariate analysis did not substantially affect the graded relation between phosphate and the risk of death (P for trend=0.03). We also considered several secondary outcomes, including the development of symptomatic congestive heart failure, fatal or nonfatal myocardial infarction, and ischemic or nonischemic stroke and the composite of death from coronary heart disease (including fatal myocardial infarction, either definite or probable; sudden death; death during a coronary intervention; and death from other coronary causes) or nonfatal myocardial infarction confirmed by serum creatine kinase measurements. The fully adjusted risk of mortality in the highest category of phosphate was 1.32 (95% CI, 0.90 to 1.94) compared with the referent group (Table 3 and Figure 1). Some of the richest phosphorus sources include dairy products, meat and fish. Respiratory System: Respiratory difficulty. Phosphorus supplements that contain sodium can cause edema in people with heart failure or cirrhosis. The heart rate increase could be attributed to a … During nearly 60 months of follow-up, 375 participants died. It sometimes manifests in chest pain and heart rhythm dysfunction. Multivariate linear regression was used to determine factors associated with baseline serum phosphate levels. Adjusted Association Between Serum Phosphate Level and Clinical Outcomes. HRs have been adjusted for age, sex, race, smoking status, diabetic status, waist-to-hip circumference ratio, fasting glucose, GFR hemoglobin, serum albumin, aspirin use, and left ventricular ejection fraction (all at baseline). Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), Journal of the American Heart Association (JAHA), Customer Service and Ordering Information, November 17, 2020: Vol. Download figureDownload PowerPointFigure 2. Backward and forward stepwise selection techniques obtained similar results, and variables that were significant at the P<0.2 level during backward stepwise selection were included in the final model for the relation between phosphate and all-cause death. Dangerous calcium deposits can … This hypothesis is supported by data indicating that diet-induced reductions in serum phosphate levels lead to increased calcitriol levels in healthy men.22,23 Because no information on 25-hydroxyvitamin D or calcitriol levels was available to us, however, this hypothesis requires further study. Potassium is especially important for your heart's electrical activity, a function that an electrocardiogram, or EKG, records. Guest editor for this article was Donna K. Arnett, MD. This can cause you to feel lightheaded or faint. Probability values for trend are as follows: All-cause death, P=0.03; new symptomatic heart failure (CHF), P=0.03; fatal or nonfatal myocardial infarction (MI), P=0.03; and coronary death or nonfatal myocardial infarction, P=0.03. © American Heart Association, Inc. All rights reserved. We had unlimited access to the data used in this analysis, and the rights to publication reside contractually with the investigators. Healthy kidneys get rid of phosphorus in the urine. The median duration of follow-up was 59.7 months. Serum phosphorus primarily occurs in the form of inorganic phosphate, which is maintained within the physiological range by regulation of dietary absorption, bone formation, and renal excretion, as well as equilibration with intracellular stores.1–4. More importantly, all energy production and energy storage activities require phosphorus. Higher-than-average alcohol consumption, %, Treatment in the United States (vs Canada), %, Renal function, blood pressure, and ejection fraction. ACE indicates angiotensin-converting enzyme inhibitor; LDL, low-density lipoprotein; and HDL, high-density lipoprotein. Suzanne Fantar has been writing online since 2009 as an outlet for her passion for fitness, nutrition and health. © Copyright 2020 Hearst Communications, Inc. In addition to age, race, and sex, baseline variables considered for inclusion in the multivariate model were smoking status; alcohol use; diabetic status; use of β-adrenergic blockers, thiazide diuretics, aspirin, and pravastatin; GFR; systolic and diastolic blood pressures; hemoglobin; serum calcium; serum albumin; waist-to-hip circumference ratio; body mass index; left ventricular ejection fraction; fasting serum glucose; fasting serum triglyceride; low-density lipoprotein cholesterol; high-density lipoprotein cholesterol; total cholesterol; and country of treatment (the United States or Canada). Baseline characteristics of study participants are shown in Table 1. This formula has been shown to have good agreement with iothalamate measurements of GFR.12 Participants with GFR <60 mL/min/1.73 m2 body surface area were considered to have chronic kidney disease as per recent guidelines.12 In sensitivity analyses, we used the Cockcroft-Gault equation13 or serum creatinine as alternative estimates of kidney function. Local Info Baseline Characteristics of Participants By Baseline Serum Phosphate Level. Most cases of shortness of breath are due to heart or lung conditions. Use of β-adrenergic blockers and higher levels of alcohol consumption were also associated with higher serum phosphate levels, although the magnitude of the increase was small. https://doi.org/10.1161/CIRCULATIONAHA.105.553198, National Center To varying degrees, your cells, tissues and organs all depend on potassium to function normally. One reason this can happen is that elevated phosphorus levels reduce your body's ability to make vitamin D, which in turn leads to calcification in your heart's blood vessels. This can also cause your calcium levels to rise. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Vitamin and mineral supplements rarely provide more than 15 percent of the RDA, but most foods contain phosphorus.

Ridgewood, Nj Demographics, Soup Pack Spar, Why Is Popeyes So Popular All Of A Sudden, Warana Shrikhand Price, Human Rights Issues In Poland, Galapagos Passion Flower, Dried Strawberry Recipe Ideas, Extra Large Pickling Jars,

Leave a Comment