Soluble klotho and mortality: The Ludwigshafen Risk and Cardiovascular Health Study. Issue 2 (October 2015)

• Record Type: Journal Article
• Authors: Brandenburg, Vincent M.; Kleber, Marcus E.; Vervloet, Marc G.; Larsson, Tobias E.; Tomaschitz, Andreas; Pilz, Stefan; Stojakovic, Tatjana; Delgado, Graciela; Grammer, Tanja B.; Marx, Nikolaus; März, Winfried; Scharnagl, Hubert
• Is Part Of: Atherosclerosis. Volume 242:Issue 2(2015)
• Page Start: 483
• Page End: 489
• Publication Date: 2015-10
• Subjects: Coronary artery disease -- Coronary angiography -- Fibroblast growth factor 23, FGF23 -- Cardiovascular events -- Outcome; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2015.08.017
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background: Experimental evidence suggests that soluble klotho (s-klotho), a co-receptor for fibroblast growth factor 23 (FGF23), may modulate cardiovascular risk through multiple mechanisms. However, the predictive value of s-klotho in patients remains unclear. Therefore, the present study examined in a large cohort of patients referred for coronary angiography whether s-klotho is associated with cardiovascular and total mortality. Methods: The longitudinal associations between baseline s-klotho and FGF23 concentrations and mortality were evaluated in 2948 participants of the Ludwigshafen Risk and Cardiovascular Health Study (LURIC), referred for coronary angiography. Results: Mean age of participants was: 63 ± 10 years. Patients with diabetes mellitus (n = 1136) had elevated s-klotho: [440 (430–449) versus 414 (406–421) pg/mL, p < 0.001]. S-klotho decreased in parallel to glomerular filtration rate (GFR) and increased in parallel to FGF23. During a median follow-up of 9.9 years, 874 deaths (30%) occurred, 539 (18%) of which were cardiovascular. After adjustment for cardiovascular risk factors, the hazard ratios in the fourth quartile compared to the first quartile of s-klotho were 1.14 (95%CI, 0.94–1.38; p = 0.187) for all-cause mortality and 1.03 (95%CI, 0.80–1.31; p = 0.845) for cardiovascular mortality. Excess mortality prediction by high levels of baseline FGF23 was not modified by adjustment for baseline s-klotho levels. Conclusions: Klotho does not add predictive power to cardiovascular and mortality risk assessment in patients with normal renal function. Highlights: We evaluate the role of soluble klotho as mortality risk factor in patients with coronary angiography. Soluble klotho levels do predict mortality risk over 9.9 years of follow-up. Soluble klotho adds little to future risk prediction, which clarifies an important aspect within the klotho-FGF23-axis.