Phosphate levels and cardiovascular disease in the general population

Phosphate levels are consistently linked with cardiac calcification, cardiovascular disease (CVD), and death in populations with chronic kidney disease. In addition, mechanistic insights suggest that phosphate levels that span the conventional normal range could lead to CVD. Examining these associations in the general population may be relevant because several interventions that may be suitable for primary or secondary prevention trials already exist. This review summarizes findings described from several community-based, prospective, observational studies. Graded associations with cardiac calcification, left ventricular hypertrophy, cardiovascular events, and death were evident, and cardiovascular risk seemed to accelerate with phosphate >3.5 to 4.0 mg/dl. Although the cause of these associations remains to be determined, several existing interventions may allow in-depth examination of the hypothesis that reducing phosphate levels could prevent CVD in the general population. Even as proof-of-concept trials and mechanistic studies are awaited, phosphate levels may be useful for cardiovascular risk stratification in adults without overt kidney disease.