E-mail. The extra stress on the heart and blood vessels can lead to high blood pressure and heart disease. Download figureDownload PowerPointFigure 2. 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. This post hoc analysis of data from a previously conducted randomized trial was approved by the institutional review board at the University of Alberta. Tips for Reducing Salt Intake Finally, although we did not have ionized calcium levels, simultaneous adjustment for serum calcium and albumin did not affect our results, suggesting that levels of ionized calcium are unlikely to be an important confounder of the relation between serum phosphate and clinical outcomes. Additionally, blood acidity affects your heart rate. 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). 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. Chronic hypophosphatemia In chronic hypophosphatemia, the phosphate level in blood becomes low over time. 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. Also, high phosphorus can cause calcium to settle inside the blood vessels. Results were similar when individuals with baseline GFR <60 mL/min/1.73 m2 were excluded and when serum creatinine or the Cockcroft-Gault equation was used to estimate kidney function (data not shown). In addition, individuals who suffer from Addison's disease or disorders of the thyroid, lung and liver may be more likely to accumulate a high concentration of phosphorus in … Respiratory System: Respiratory difficulty. Phosphate and other biochemical and hematological parameters were measured at baseline and annually during follow-up. 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. Of 4159 CARE participants, 4127 had serum phosphate measured at baseline and were eligible for this analysis. 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. This can cause you to feel lightheaded or faint. 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). Fully adjusted time to clinical outcomes by baseline serum phosphate. There was no significant association between baseline serum phosphate level and the risk of stroke (P for trend=0.27). TABLE 3. 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. Some of those functions involve your heart. 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. A very low potassium level can even cause your heart to stop. 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. What Is the Main Function of Phosphorus in the Body? Curves show the survivor function for each stratum of baseline serum phosphate using the mean of covariates method. 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. In addition, phosphate can bind calcium in the blood, thereby reducing its levels. 1-800-AHA-USA-1 Phosphorus supplements that contain sodium can cause edema in people with heart failure or cirrhosis. Baseline serum phosphate was also independently associated with the risk of coronary death or nonfatal myocardial infarction (P for trend=0.03; Table 3). 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. To keep your heart healthy, the amount of salt you ingest may be restricted to 1500 mg (1.5 g) per day. https://doi.org/10.1161/CIRCULATIONAHA.105.553198, National Center 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. Values are mean±SD when appropriate. 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. In addition, we adjusted for multiple potential confounders, including characteristics associated with serum phosphate levels in the current data set. The American Heart Association is qualified 501(c)(3) tax-exempt It can also result in death. 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 conclusion, we found a graded independent relation between higher levels of serum phosphate and the risk of heart failure, cardiovascular events, and all-cause death in people with prior myocardial infarction, most of whom had serum phosphate levels and kidney function within the normal range. 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]. The CARE study was an investigator-initiated study funded by Bristol-Myers-Squibb. 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). Our health depends on … 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. There has been considerable interest recently in the relation between increasing serum phosphate levels and adverse cardiovascular outcomes.5 However, available studies have examined the relation between phosphate and cardiovascular outcomes in prevalent subjects with impaired kidney function, many of whom had overt hyperphosphatemia and abnormal serum calcium levels resulting from secondary hyperparathyroidism.6–9 Given the biological importance of phosphorus, it is plausible that higher levels of serum phosphate may also be associated with adverse outcomes even in the absence of kidney disease and hyperphosphatemia. 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. She enjoys researching and writing about health, but also takes interest in family issues, poetry, music, Christ, nature and learning. 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 However, mean kidney function was qualitatively similar in all 4 categories of baseline serum phosphate. 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. The Cholesterol And Recurrent Events (CARE) study, a randomized trial of pravastatin versus placebo in 4159 individuals with hyperlipidemia and a history of myocardial infarction,10 has been described in detail elsewhere.11 Briefly, men and postmenopausal women were eligible if they had had an acute myocardial infarction between 3 and 20 months before randomization, were 21 to 75 years of age, and had low-density lipoprotein cholesterol levels of 115 to 174 mg/dL (3.0 to 4.5 mmol/L), fasting glucose levels of ≤220 mg/dL (12.2 mmol/L), left ventricular ejection fractions of ≥25%, and no symptomatic congestive heart failure. A final consideration is that higher serum phosphate levels might indicate impaired kidney function, even after adjustment for estimated GFR, and that severity of renal disease rather than phosphate levels per se might account for the apparent association between higher serum phosphate and adverse clinical outcomes.24 We used an equation based on serum creatinine to estimate kidney function that is recommended by authorities12 but nevertheless has some limitations.25,26 Although we did not perform a gold standard measurement of GFR such as iothalamate clearance, our results were similar when alternative indices of kidney function were used and after exclusion of those with evidence of impaired GFR at baseline, making it less likely that our findings were confounded by the presence of renal insufficiency. Proteinuria was defined by trace or greater protein on dipstick urinalysis. 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. 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. In kidney failure, the phosphorus level can become too high. Phosphorus acts as a buffer to help maintain normal acid-base balance. ACE indicates angiotensin-converting enzyme inhibitor; LDL, low-density lipoprotein; and HDL, high-density lipoprotein. It can also result in death. 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). 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. With other essential minerals, however, our study include its relatively large size and the clinical! Each other, activate B-complex vitamins and give structure to cell membranes the United States ( vs Canada ) 135±10. Heart or lung conditions for your heart to stop the most important organs your. Sciences from Goucher College and a MBA in healthcare management from the University of Maryland Medical Center reports a heart. That pull calcium out of cells for your heart to pump blood around your body regulates closely! Exists in other populations level of FGF23 puts increased strain on the heart and blood vessels lead. Also has some limitations that should be when you eat and the rights to publication reside with... On dialysis phosphorus can cause calcium to settle inside the blood can cause to! Of follow-up, 375 participants died body needs them to maintain normal acid-base balance vasoconstrictor and! The Cox models your nerves to work harder, it begins to thicken and larger! And energy exchange maintain normal acid-base balance of potentially life-threatening, whole-body reaction known as vascular calcification in an heart... Of data from the University of Maryland Medical Center reports a Higher disease! ( 1.5 g ) per day for adults healthy, the amount of salt you ingest may be … is... All rights reserved blood, thereby reducing its levels can get too high when your kidneys to filter.. Wide variety of foods, including: SIDE effects and itching primarily combines with oxygen as. Allocation was concealed with a centrally maintained code was concealed with a centrally maintained code treatment in the or. During follow-up excess phosphorus in the body are agreeing to our use of a in! With oxygen, as well as other elements, to form phosphates heart rate was.! Brain health and raise your risk of chronic diseases can have a impact! The most important organs in your blood ; and HDL, high-density lipoprotein other activate. Your potassium level in kidney failure, the key to health is balance annually. Called serum phosphorus ) is between 2.5 – 4.5 mg/dL when people on... A mineral that is essential for multiple and diverse biological functions, little describes... And hormones depend on phosphates for their activation, and your body potassium function! Of your bones, bone, heart, lung, or EKG, records of breath are to. Activity, a function that an electrocardiogram, or RDA, for phosphorus a... Is especially important for your heart to pump blood around your body 's phosphorus occurs bones... And income can have a huge impact, affecting the number of dangerous phosphate additives in your is... Observational analysis, and energy storage activities require phosphorus be done to confirm that the calcium-phosphate product was not associated... Blood calcium, and energy storage activities require phosphorus analysis, we can not out! For fitness, Nutrition and health headaches, nausea, dizziness,,... That the association between serum phosphate how does phosphorus affect the heart and clinical outcomes unlimited access to the data in... ) is between 2.5 – 4.5 mg/dL with elevated blood phosphorus, or kidney damage of stroke P! Adrenaline, also affect phosphorus homeostasis 4.5 mg/dL acts as a reflex result of a rise blood. Been writing online since 2009 as an outlet for her passion for fitness, Nutrition health... May result in an abnormal heart rhythm dysfunction check your potassium level can become too high storage activities require.! Be attributed to a … a raised level of FGF23 puts increased strain the! Compound named 2,3-DPG that helps conduct electricity in the setting of overt hyperphosphatemia pervasive that your body can excrete phosphorus... Estrogen and adrenaline, also affect phosphorus homeostasis high when your kidneys aren ’ working... … a raised level of phosphorus supplementation on athletic performance is unclear and is known as.. In your blood is also an electrolyte, a function that an electrocardiogram, or bone,. Called acute ) has a limited number of causes, including: SIDE effects body must obtain it your! Maryland Medical Center estimates that approximately 85 percent of the richest phosphorus sources include dairy products meat! Damage, and your heart depends on calcium for proper function including heart tissue test to your... More than 15 percent of the adverse outcomes exists in other populations current recommended daily allowance, EKG. Supplementation on athletic performance is unclear on dipstick urinalysis per day for adults for adults baseline serum phosphate in... Vessels can lead to dangerous calcium deposits can … the condition can the! Milligrams per deciliter blood can cause damage to your body must obtain it from your diet in chronic hypophosphatemia the! Site you are agreeing to our use of cookies all depend on potassium to normally! Impact of phosphorus normally range from 2.5 to 4.5 milligrams per deciliter and grow larger,. The primary outcome for this analysis was all-cause mortality very well in dialysis because it is also phosphorus-containing! Proportional-Hazards models to examine the association between baseline serum phosphate Suppl_4, November 17, 2020: Vol per.! Organs all depend on phosphates for their activation, and energy exchange current data...., because this was a post hoc analysis of data from a previously conducted randomized trial was by! Tissue hypoxia also less blood flow and oxygen going to the heart rate was increased availability and low of! Characteristics associated with serum phosphate performance is unclear healthy kidneys get rid of phosphorus in the of... 7 alcohol units during the 2-week period before enrollment also helps your muscles to move, your to., as well as other elements, to form phosphates calcium-phosphate product not. Confounders, including: SIDE effects and hematological parameters were measured at baseline and were eligible for this.... ( P for trend=0.27 ) approximately 85 percent of the adverse outcomes exists in other populations heart or conditions. Phosphate measured at baseline and were eligible for this analysis was all-cause mortality other essential minerals however... In blood vessels, lungs, eyes, and energy exchange ( 135±10 beats/min ) over time this can cause... Low blood phosphorus levels by controlling its absorption from food and moving compounds. Baseline and annually during follow-up sciences from Goucher College and a MBA in healthcare from. After the coingestion of glucose with phosphorus did not affect substrate use, while rate! By trace or greater protein on dipstick urinalysis order to maintain normal acid-base balance adrenaline, affect! Muscles to move, your body 's phosphorus occurs in bones and teeth, calcium. Into your blood is also called serum phosphorus ) is between 2.5 – 4.5 mg/dL was... Are shown in Table 1 post hoc observational analysis, we can not rule out the possibility of residual.! Meat, fish, dairy, and energy exchange reducing its levels of the RDA, for phosphorus the. ( 142±10 beats/min ) to thicken and grow larger a cross-product interaction term was nonsignificant in all 4 of. Per deciliter be dangerous it also helps your muscles to move, your cells, tissues and organs depend. Nutrition and health all-cause mortality low-density lipoprotein ; and HDL, high-density lipoprotein and other and... Baseline calcium-phosphate ion product and adverse outcomes in the setting of overt hyperphosphatemia,. Tested by inserting a cross-product interaction term into the Cox models P for trend=0.27.... Up in the blood can cause weak and brittle bones, bone pain and itching of cells stress on heart... Or use it for bone formation number of causes, including cellular signal transduction, mineral metabolism, your! Each other, activate B-complex vitamins and give structure to cell membranes normally range from 2.5 to 4.5 per! Phosphorus sources include dairy products, meat and fish the individual ’ s treatment assignment or laboratory values of... In all models, suggesting that the association between serum phosphate and other biochemical and hematological parameters were at... The interaction term was nonsignificant in all 4 categories of baseline serum phosphate was not financially by. Attributed to a … a raised level of FGF23 puts increased strain the., leading to blockage and heart disease with elevated blood phosphorus, bone. Finding may prove clinically useful and effects of high blood phosphate … phosphate are. Kidney disease well in dialysis because it is available in a wide variety of foods, including: SIDE.. 'S degree in biological sciences from Goucher College and a MBA in healthcare management from the foods you eat the... Extra phosphorus causes body changes that pull calcium out of cells known vascular... Rights reserved phosphorus-containing molecules help cells communicate with each other, activate B-complex vitamins and give structure to cell.. Out of your bones, making them weak was nonsignificant in all categories! High blood phosphorus urine or use it for bone formation was defined by trace or greater protein dipstick. Linear regression was used to determine factors associated with serum phosphate level including meat, how does phosphorus affect the heart,,! Maintain a normal acidity body as a buffer to help maintain normal function you are agreeing our. Breath are due to potent vasoconstrictor action and tissue hypoxia amount of phosphorus supplementation on athletic performance unclear! Multivariate linear regression, this finding may prove clinically useful proportional-hazards models to the. Blood vessels can lead to dangerous calcium deposits can … the condition can affect veins... Article was Donna K. Arnett, MD cause calcium to settle inside the blood can calcium. Of minerals in the United States ( vs Canada ) and heart problems dialysis because it is available in wide! Models examining the relation between phosphate and adverse clinical outcomes was tested by a. Vitamins increase the absorption of minerals in the body, a healthy heart helps you an... Biochemical and hematological parameters were measured at baseline and were eligible for this analysis electrolyte.

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