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. Shortness of breath that comes on suddenly (called acute) has a limited number of causes, including: Proteinuria was defined by trace or greater protein on dipstick urinalysis. Your body regulates potassium closely in order to maintain normal function. Healthy kidneys remove extra phosphorus from the blood. After stratification according to clinical center, eligible and consenting participants were assigned by computer-generated random order in a double-blinded fashion to receive either 40 mg pravastatin (Pravachol, Bristol-Myers Squibb) once daily or placebo. 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). 1-800-242-8721 A second possibility is that high blood phosphorus directly causes mineral buildup in blood vessels, leading to blockage and heart problems. We found a graded, independent association between baseline fasting serum phosphate level and the risk of all-cause death, development of new heart failure, and coronary events in this population of individuals with previous myocardial infarction, most of whom had serum phosphate levels within the normal range. Dallas, TX 75231 TABLE 1. This formula has been shown to have good agreement with iothalamate measurements of GFR.12 Participants with GFR <60 mL/min/1.73 m2 body surface area were considered to have chronic kidney disease as per recent guidelines.12 In sensitivity analyses, we used the Cockcroft-Gault equation13 or serum creatinine as alternative estimates of kidney function. 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 In addition, phosphate can bind calcium in the blood, thereby reducing its levels. This site uses cookies. Guest editor for this article was Donna K. Arnett, MD. Also, high phosphorus can cause calcium to settle inside the blood vessels. Cardiovascular Disease Hardening of arteries, called atherosclerosis, and calcification of the tissues in the heart due to excess phosphorus levels significantly … Your health care provider will order a blood test to check your potassium level. 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). Curves show the survivor function for each stratum of baseline serum phosphate using the mean of covariates method. If the deficiency is severe enough, death can result. More importantly, all energy production and energy storage activities require phosphorus. The University of Maryland Medical Center estimates that approximately 85 percent of the body's phosphorus occurs in bones and teeth, alongside calcium. PDF | Objective The impact of phosphorus supplementation on athletic performance is unclear. Phosphorus metabolism is tightly bound to that of calcium – both minerals are affected by the same hormones, usually in the opposite direction. The heart rate increase could be attributed to a … High phosphorus levels might also promote heart disease by triggering a hormone called parathyroid hormone, which puts the body in a state of inflammation. For example, mean GFR was 68.2 mL/min/1.73 m2 in subjects with serum phosphate <2.5 mg/dL and 72.8 mL/min/1.73 m2 in those with serum phosphate ≥4 mg/dL. 1-800-AHA-USA-1 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. Many enzymes and hormones depend on phosphates for their activation, and your body needs them to maintain a normal acidity. 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). Most cases of shortness of breath are due to heart or lung conditions. However, our study also has some limitations that should be considered. 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. 142, Issue Suppl_3, October 20, 2020: Vol. Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), Journal of the American Heart Association (JAHA), Customer Service and Ordering Information, November 17, 2020: Vol. The median duration of follow-up was 59.7 months. A raised level of FGF23 puts increased strain on the heart. 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). Further studies are required to determine the explanation for the association between phosphate and adverse clinical outcomes and to confirm that this relation is present in other populations. Strengths of our study include its relatively large size and the use of a central laboratory for all biochemical measurements. If you have too much phosphorus in your body for a long period of time, your chance of a heart attack or stroke goes up. TABLE 2. Fully adjusted risk of clinical outcomes by baseline serum phosphate. To keep your heart healthy, the amount of salt you ingest may be restricted to 1500 mg (1.5 g) per day. Some of those functions involve your heart. 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. During nearly 60 months of follow-up, 375 participants died. This is for an otherwise healthy person. 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. Further adjustment for factors independently associated with mortality using stepwise multivariate analysis did not substantially affect the graded relation between phosphate and the risk of death (P for trend=0.03). When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Phosphate supplements are considered safe if taken as prescribed. 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. Background— Higher levels of serum phosphate are associated with adverse cardiovascular outcomes, especially in the setting of overt hyperphosphatemia. She enjoys researching and writing about health, but also takes interest in family issues, poetry, music, Christ, nature and learning. Phosphorus primarily combines with oxygen, as well as other elements, to form phosphates. 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. Increased blood volume makes it harder for your heart to pump blood around your body. For example, after adjustment for age, race, and sex, participants with serum phosphate ≥4 mg/dL had an HR for death of 1.42 (95% CI, 0.97 to 2.07) compared with those with serum phosphate of 2.5 to 3.4 mg/dL. 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. Several recent studies demonstrate that higher levels of phosphate are associated with an increased risk of all-cause and cardiovascular death when kidney function is impaired, especially in people with end-stage renal disease.6–9 Vascular calcification has been postulated as the link between hyperphosphatemia and adverse outcomes in the setting of kidney disease, perhaps accelerated by abnormal calcium levels and hyperparathyroidism.5,16 However, unlike participants in the present trial (only 5.2% of whom had hyperphosphatemia at baseline), many of the subjects in these previous studies had overt hyperphosphatemia or were receiving medications that may have influenced the association between serum phosphate and outcome. 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. Given the ready availability and low cost of serum phosphate assays, this finding may prove clinically useful. Some of the richest phosphorus sources include dairy products, meat and fish. Anorexics, alcoholics, diabetics and those with certain digestive disorders are especially at risk for phosphorus deficiency, according to the University of Maryland Medical Center. In addition, mean serum phosphate levels were similar in people with and without baseline GFR <60 mL/min/1.73 m2 (3.3±0.5 versus 3.3±0.5 mg/dL; P>0.9). 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. Although we did not have data on parathyroid hormone levels, we controlled for estimated GFR and for other factors that might be associated with hyperparathyroidism such as serum calcium and albumin. There was no significant association between baseline serum phosphate level and the risk of stroke (P for trend=0.27). TABLE 3. Curves show the survivor function for each stratum of baseline serum phosphate using the mean of covariates method. © Copyright 2020 Hearst Communications, Inc. 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). There is also less blood flow and oxygen going to the heart. 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. Higher-than-average alcohol consumption, %, Treatment in the United States (vs Canada), %, Renal function, blood pressure, and ejection fraction. Customer Service Baseline characteristics of study participants are shown in Table 1. 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. E-mail. Deaths were reviewed by the outcomes committee without knowledge of the individual’s treatment assignment or laboratory values. Analyses were performed with Stata 8 SE software. What Vitamins Increase the Absorption of Minerals in the Body? Interactions. Similar findings were noted when the development of new symptomatic heart failure was considered. 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. What Is the Main Function of Phosphorus in the Body? 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. Given the ready availability and low cost of serum phosphate assays, this finding may prove clinically useful. A very low potassium level can even cause your heart to stop. Compared with models with adjustment only for age, race, and sex, additional adjustment for potential confounders (including medication use and left ventricular ejection fraction) slightly attenuated but did not abolish the association between serum phosphate and adverse outcomes. Normal kidneys help to get rid of phosphorus. The interaction term was nonsignificant in all models, suggesting that the calcium-phosphate product was not independently associated with any of the adverse outcomes. 142, Issue 16_suppl_1, October 20, 2020: Vol. 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. Multivariate linear regression was used to determine factors associated with baseline serum phosphate levels. Phosphorus is a mineral that is essential for human health. It is also an electrolyte, a substance that helps conduct electricity in the body. White phosphorus has been found in at least 77 of the 1,416 National Priorities List sites identified by the Environmental Protection Agency (EPA). Given the biological importance of phosphorus, it is plausible that higher levels of serum phosphate within the normal range may also be associated with adverse outcomes. Learn more about its benefits here. This substudy on serum phosphate was not financially supported by industry. The risk of stroke was not significantly increased in participants with serum phosphate ≥4 mg/dL compared with those with serum phosphate of 2.5 to 3.4 mg/dL (adjusted HR, 0.93; 95% CI, 0.46 to 1.85). This can cause you to feel lightheaded or faint. 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. Phosphorus' mere involvement in all energy production makes it an indispensable partner to your heart since, like all organs, your heart needs energy in order to function. 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. Your phosphorus levels can get too high when your kidneys aren’t working correctly. You get them from the foods you eat and the fluids you drink. 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. Allergies to phosphate are rare, but it's still important to call your doctor or seek emergency care if you experience rash, hives, shortness of breath, rapid heartbeat, or swelling of the face, throat, or tongue after taking a phosphate supplement. 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. Phosphorus is not removed very well in dialysis because it is a big molecule. use prohibited. Conclusion Exercise performance 3 hours after the coingestion of glucose with phosphorus did not affect substrate use, while heart rate was increased. Baseline serum phosphate levels were measured in 4127 fasting participants who were randomized to receive pravastatin 40 mg daily or placebo and followed up for a median of 59.7 months. A strong heart efficiently pumps blood to all the tissues of your body, providing each cell with the oxygen and nutrients needed to get you through the day. 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. 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