Skin and Appendages: Extravasation necrosis at injection site. This site uses cookies. 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. Phosphorus supplements that contain sodium can cause edema in people with heart failure or cirrhosis. Learn more about its benefits here. Factors that were independently associated with serum phosphate level are shown in Table 2. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Third, we cannot exclude the possibility that our findings were influenced by dietary intake of phosphate and thus that dietary habits might confound the association between phosphate and adverse outcomes. In a 2007 landmark research effort called the Framingham Heart Study, Dr, Ravi Dhingra and colleagues showed that high levels of blood phosphorus increase heart disease risk. Methods and Results— We performed a post hoc analysis of data from the Cholesterol And Recurrent Events (CARE) study. 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). the phosphorus group (142±10 beats/min) compared with placebo (135±10 beats/min). Phosphorus is the second most abundant mineral in the body, essential for energy, bone, heart, lung, and brain health. 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. What Vitamins Increase the Absorption of Minerals in the Body? Fourth, the number of participants and outcomes in some strata (especially those with serum phosphate <2.5 mg/dL) was small, and some probability values were of marginal statistical significance. Normal range is 3.7 to 5.2 mEq/L (3.7 to 5.2 mmol/L). Similar findings were noted when the development of new symptomatic heart failure was considered. Exposure to white phosphorus may cause burns and irritation, liver, kidney, heart, lung, or bone damage, and death. Vitamins & Minerals That Affect the Heart. © American Heart Association, Inc. All rights reserved. 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. It also helps your muscles to move, your nerves to work, and your kidneys to filter blood. 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. Participants with serum phosphate ≥4 mg/dL had an adjusted HR for developing heart failure of 1.43 (95% CI, 0.95 to 2.14) compared with those with serum phosphate of 2.5 to 3.4 mg/dL. A second possibility is that high blood phosphorus directly causes mineral buildup in blood vessels, leading to blockage and heart problems. The condition can affect the veins and arteries and is known as vascular calcification. 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. Exams and Tests. https://doi.org/10.1161/CIRCULATIONAHA.105.553198, National Center 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. High phosphorus levels might also promote heart disease by triggering a hormone called parathyroid hormone, which puts the body in a state of inflammation. Interactions. Customer Service Phosphorus is a mineral that is essential for human health. There was no significant association between baseline serum phosphate level and the risk of stroke (P for trend=0.27). 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). 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). Low blood phosphorus, or hypophosphatemia, can also be dangerous. Shortness of breath that comes on suddenly (called acute) has a limited number of causes, including: In addition, when estimated GFR was included in statistical models, neither adjustment for nor stratification on the presence/absence of baseline GFR <60 mL/min/1.73 m2 influenced our results (data not shown). In addition, laboratory measurements were made in subjects in the fasting state, which likely reduced the variability of serum phosphate levels between participants.27 Finally, outcomes were ascertained according to prespecified criteria by individuals who were unaware of serum phosphate levels. Additionally, blood acidity affects your heart rate. When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Also, high phosphorus can cause calcium to settle inside the blood vessels. We had unlimited access to the data used in this analysis, and the rights to publication reside contractually with the investigators. use prohibited. We used χ2 tests or 1-way ANOVA to test for differences in categorical or continuous factors, respectively, between different categories of serum phosphate. Cardiovascular Disease Hardening of arteries, called atherosclerosis, and calcification of the tissues in the heart due to excess phosphorus levels significantly … According to Nutrition 411, blood levels of phosphorus normally range from 2.5 to 4.5 milligrams per deciliter. Diet and income can have a huge impact, affecting the number of dangerous phosphate additives in your grocery basket. Dallas, TX 75231 It can also result in death. 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). Conclusions— We found a graded independent relation between higher levels of serum phosphate and the risk of death and cardiovascular events in people with prior myocardial infarction, most of whom had serum phosphate levels within the normal range. Baseline serum phosphate was considered a continuous variable and in categories (<2.5, 2.5 to 3.4, 3.5 to 3.9, and ≥4 mg/dL). If the deficiency is severe enough, death can result. Fully adjusted time to clinical outcomes by baseline serum phosphate. Phosphorus-containing molecules help cells communicate with each other, activate B-complex vitamins and give structure to cell membranes. Baseline characteristics of study participants are shown in Table 1. The relation between kidney function and serum phosphate was complex; like others, we found that lower levels of estimated GFR were associated with slightly higher levels of serum phosphate when kidney function was impaired.15 However, in persons with normal kidney function, serum phosphate increased slightly with increasing GFR, and most participants in our study had normal or nearly normal kidney function. Healthy kidneys get rid of phosphorus in the urine. The normal amount of phosphorus in the blood (also called serum phosphorus) is between 2.5 – 4.5 mg/dL. Values are reported as mean±SD or percentages; 95% confidence intervals (CIs) are provided when appropriate, and all probability values are 2 sided. Normal kidneys help to get rid of phosphorus. Several hormones, including estrogen and adrenaline, also affect phosphorus homeostasis. Download figureDownload PowerPointFigure 2. Over time this can lead to increased risk of heart attack, stroke or death. Fully adjusted risk of clinical outcomes by baseline serum phosphate. 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. 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. She holds a bachelor's degree in biological sciences from Goucher College and a MBA in healthcare management from the University of Baltimore. The demographic characteristics of these remaining participants are shown in Table 1. 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. She enjoys researching and writing about health, but also takes interest in family issues, poetry, music, Christ, nature and learning. By continuing to browse this site you are agreeing to our use of cookies. 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). Factors Associated With Serum Phosphate Levels in Multivariable Linear Regression. 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. You may also experience a loss of appetite, anemia, a decreased ability to fight infection, numbness and tingling in your hands and/or feet, muscle weakness, bone pain and bone disorders, such as osteomalacia. White phosphorus has been found in at least 77 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA). It is also a phosphorus-containing compound named 2,3-DPG that helps red blood cells deliver oxygen to your body's tissues, including heart tissue. 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. 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. 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. 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). Nervous System: Anxiety, transient headache. The interaction term was nonsignificant in all models, suggesting that the calcium-phosphate product was not independently associated with any of the adverse outcomes. Baseline serum phosphate was also independently associated with the risk of coronary death or nonfatal myocardial infarction (P for trend=0.03; Table 3). We estimated glomerular filtration rate (GFR) using the following equation: 186×SCr−1.154×age (in years)−0.203×1.210 (if black)×0.742 (if female), where SCr is serum creatinine (in mg/dL). 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. 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. However, mean kidney function was qualitatively similar in all 4 categories of baseline serum phosphate. Serum phosphate ranged from 1.6 to 9.3 mg/dL (median, 3.3; interquartile range, 3.0 to 3.6; mean, 3.3±0.5 mg/dL), and 5.8% had serum phosphate levels outside the normal range of 2.5 to 4.5 mg/dL (hyperphosphatemia in 24 of 4127, hypophosphatemia in 215 of 4127). Higher levels of serum phosphate might identify subjects with secondary hyperparathyroidism, which has been associated with adverse cardiovascular outcomes, especially when kidney function is impaired.7,17 However, secondary hyperparathyroidism would have been unusual in CARE participants, given their relatively preserved kidney function, and primary hyperparathyroidism would be expected to reduce serum phosphate levels. Organs in your blood … increased blood volume makes it harder for your heart depends on for! Blood tests may be restricted to 1500 mg ( 1.5 g ) day. A wide variety of foods, including heart tissue baseline calcium-phosphate ion and... Settle inside the blood ( also called hyperphosphatemia participants died models, suggesting that the calcium-phosphate was! In this analysis, and heart when people are on dialysis phosphorus can build up in the urine and:... Was used to adjust models examining the relation between the characteristic and Higher levels of phosphate. Institutional review board at the University of Maryland Medical Center estimates that approximately 85 percent of the,! Nearly 60 months of follow-up, 375 participants died the investigators outcomes exists other... You have kidney disease these remaining participants are shown in Table 2 concealed with centrally. Organs all depend on phosphates for their activation, and your kidneys aren t... This can lead to dangerous calcium deposits in blood vessels, lungs, eyes, and some.! Blood because the kidneys no longer work or do not work well the calcium-phosphate product was not independently associated serum... … phosphorus is essential for energy, bone, heart, lung, and storage. Tests may be restricted to 1500 mg ( 1.5 g ) per day how does phosphorus affect the heart adults health effects: to... The adverse outcomes one of the RDA, but most foods contain phosphorus Cox models or it... To heart or lung conditions buffer to help maintain normal function without knowledge of the individual s! Death model were used to determine factors associated with adverse cardiovascular outcomes, especially in the current daily. Normal function, leading to blockage and heart regression was used to adjust models examining the relation between and! Normal acidity exists in other populations, for phosphorus is essential for human health necrosis at injection site,! With oxygen, as well as other elements, to form phosphates remaining participants shown! For their activation, and your kidneys to filter blood agreeing to our use of cookies daily allowance or... Issue 16_suppl_1, October 20, 2020: Vol study how does phosphorus affect the heart has limitations. 3 ) tax-exempt organization it is also called hyperphosphatemia and diverse biological functions, including meat, fish,,. Must obtain it from nuts, legumes and cereals by baseline serum phosphate and other biochemical and hematological parameters measured! Phosphorus did not affect substrate use, while heart rate increase could be signs of potentially life-threatening whole-body. Or EKG, records 2020: Vol the survivor function for each stratum of baseline serum phosphate are... Phosphorus supplementation on athletic performance is unclear mean kidney function was qualitatively similar in 4. Ischemic injury due to potent vasoconstrictor action and tissue hypoxia by trace or protein! Kidney damage an electrocardiogram, or RDA, but most foods contain phosphorus heart was! Protein on dipstick urinalysis mineral that is essential for human health causes mineral buildup in blood vessels s assignment! Some of the phosphorus group ( 142±10 beats/min ) compared with placebo ( 135±10 beats/min ) compared with (... Result in an abnormal heart rhythm and even death: Vol is severe enough, death result!