High serum phosphorus levels have been linked with vascular calcification and greater
cardiovascular morbidity and mortality. We assessed whether serum phosphorus was associated
with the atrial fibrillation (AF) incidence in a large community-based cohort in the
United States. Our analysis included 14,675 participants (25% black, 45% men) free
of AF at baseline (1987 to 1989) and with measurements of fasting serum phosphorus
from the Atherosclerosis Risk In Communities (ARIC) study. The incidence of AF was
ascertained through the end of 2008 from study visit electrocardiograms, hospitalizations,
and death certificates. Cox proportional hazard models were used to estimate the hazard
ratios of AF by the serum phosphorus levels, adjusting for potential confounders.
During a median follow-up of 19.7 years, we identified 1,656 incident AF cases. Greater
serum phosphorus was associated with a greater AF risk: the hazard ratio of AF with
a 1-mg/dl increase in serum phosphorus was 1.13 (95% confidence interval 1.02 to 1.26).
No significant interaction was seen by race (p = 0.88) or gender (p = 0.51). The risk
of AF was increased in association with greater serum phosphorus in those with an
estimated glomerular filtration rate of ≥90 ml/min/1.72 m2 but not among those with an estimated glomerular filtration rate of <90 ml/min/1.72
m2. The total corrected calcium levels were not related to AF risk; however, greater
levels of the calcium-phosphorus product were associated with greater AF risk. In
conclusion, in the present large population-based study, greater levels of serum phosphorus
and the related calcium-phosphorus product were associated with a greater incidence
of AF.
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Article info
Publication history
Accepted:
November 21,
2012
Received in revised form:
November 21,
2012
Received:
September 11,
2012
Footnotes
The Atherosclerosis Risk In Communities Study was performed as a collaborative study supported by contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C from the National Heart, Lung, and Blood Institute (Bethesda, Maryland). This study was additionally supported by grant RC1-HL099452 from the National Heart, Lung, and Blood Institute (Bethesda, Maryland) and grant 09SDG2280087 from the American Heart Association (Dallas, Texas).
See page 862 for disclosure information.
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