Fibroblast growth factor 23 and sudden versus non-sudden cardiac death: the Cardiovascular Health Study

Am J Kidney Dis. 2015 Jul;66(1):40-6. doi: 10.1053/j.ajkd.2014.10.025. Epub 2015 Jan 5.


Background: Elevated fibroblast growth factor 23 (FGF-23) concentrations are associated with greater risk of cardiovascular events and mortality, especially among people with chronic kidney disease (CKD). Because individuals with CKD are at an increased risk of sudden cardiac death (SCD), we sought to understand whether FGF-23 level is a stronger risk factor for SCD versus non-SCD.

Study design: Cohort study.

Setting & participants: 3,244 participants 65 years or older in the community-based Cardiovascular Health Study.

Predictor: Plasma FGF-23 concentrations.

Outcomes: We assessed SCD and non-SCD in these analyses. SCD was adjudicated rigorously and was defined as a sudden pulseless condition of cardiac origin in a previously stable person occurring out of hospital or in the emergency department.

Measurements: We estimated associations of baseline FGF-23 concentrations with SCD and non-SCD using Cox proportional hazards models after adjustment for demographics, cardiovascular risk factors, comorbid conditions, and kidney function. We also tested whether associations differed by CKD status.

Results: During a median follow-up of 8.1 years, there were 118 adjudicated SCD and 570 non-SCD events. After multivariable adjustment for demographics, cardiovascular risk factors, comorbid conditions, and parameters of kidney function, higher FGF-23 concentrations were an independent risk factor for non-SCD (HR [per doubling], 1.17; 95% CI, 1.06-1.30). However, elevated FGF-23 concentrations were not associated independently with SCD (HR [per doubling], 1.07; 95% CI, 0.85-1.35). In stratified analysis by CKD status (36.5% of cohort), doubling of FGF-23 concentrations was associated independently with non-SCD (adjusted HR, 1.26; 95% CI, 1.10-1.45). A similar magnitude of association was observed between FGF-23 level and SCD in the CKD subgroup; however, it was not significant (HR, 1.20; 95% CI, 0.89-1.62).

Limitations: Limited power to detect moderate-sized effects between FGF-23 level and SCD in both the primary and stratified analyses.

Conclusions: In this population-based study, FGF-23 level elevations were associated independently with non-SCD. Among individuals with CKD, the associations between FGF-23 level and SCD and non-SCD were similar.

Keywords: Cardiovascular Health Study (CHS); Fibroblast growth factor 23 (FGF-23); cardiovascular event; cardiovascular mortality; chronic kidney disease (CKD); cohort study; fatal arrhythmic event; non-SCD; renal function; sudden cardiac death (SCD).

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Comorbidity
  • Death, Sudden, Cardiac*
  • Electrocardiography
  • Female
  • Fibroblast Growth Factors / blood*
  • Follow-Up Studies
  • Heart Arrest / blood
  • Heart Diseases / blood*
  • Heart Diseases / mortality
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Prospective Studies
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / epidemiology
  • Risk Factors
  • Sympathetic Nervous System / physiopathology
  • United States / epidemiology


  • Biomarkers
  • Fibroblast Growth Factors
  • fibroblast growth factor 23