Association between blood phosphorus level and adverse outcomes in patients with coronary artery disease: A meta-analysis

Abstract

Objective: The prognostic implication of phosphorus level in patients with coronary artery disease (CAD) remains controversial. We aimed to conduct a meta-analysis to evaluate the prognostic role of blood phosphorus level in CAD patients. Methods: We searched the PubMed, Web of Science, Scopus, and Embase databases until December 28, 2023, to identify prospective or retrospective longitudinal observational studies that examined the prognostic value of blood phosphorus level in CAD patients. Outcome measures included all-cause or cardiovascular mortality, heart failure, stroke, and major adverse cardiac events (MACEs). The prognostic value of blood phosphorus level was expressed by pooling the fully adjusted hazard ratios (HR) with 95 % confidence intervals (CI) for the hypophosphatemia or hyperphosphatemia compared to the reference normal phosphorus level. Results: Six studies involving 19,553 CAD patients were included. Meta-analysis showed that the hyperphosphatemia was significantly associated with higher risk of all-cause mortality (HR 1.39; 95 % CI 1.20–1.61), cardiovascular mortality (HR 1.37; 95 % CI 1.22–1.53), heart failure (HR 1.64; 95 % CI 1.44–1.87), and MACEs (HR 1.39; 95 % CI 1.03–1.88) but not stroke (HR 1.23; 95 % CI 0.79–1.92). However, non-significant association was found between hypophosphatemia and all-cause mortality (HR 1.21; 95 % CI 0.98–1.51), cardiovascular mortality (HR 1.07; 95 % CI 0.78–1.45), heart failure (HR 0.87; 95 % CI 0.72–1.05), stroke (HR 1.12; 95 % CI 0.76–1.67), and MACEs (HR 1.16; 95 % CI 0.99–1.36). Conclusions: Hyperphosphatemia, but not hypophosphatemia independently predicts all-cause mortality, cardiovascular mortality, heart failure, and MACEs in CAD patients.

Keywords

• Coronary artery disease
• Blood phosphorus
• Mortality
• Heart failure
• Stroke
• Meta-analysis