Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis

Background: The association between elevated serum phosphorus concentration and cardiovascular or all-cause mortality yielded conflicting results. Objective: To assess the association between elevated serum phosphorus concentration and cardiovascular or all cause mortality in the general population by conducting a meta-analysis. Methods: We systematically searched the Pubmed and Embase databases until March 2016 for the prospective studies investigating serum phosphorus concentration and cardiovascular or all-cause mortality in the general population. We pooled risk ratio (RR) and corresponding 95% confidence intervals (CI) for the highest versus the reference category of serum concentration of phosphorus. Results: Six prospective cohort studies involving 120,269 subjects were identified. When compared the highest with the reference concentration of serum phosphorus, the pooled RR of cardiovascular mortality and all-cause mortality were 1.36 (95% CI 1.07-1.72) and 1.35 for all-cause mortality (95% CI 1.15-1.58), respectively. Stratified analyses revealed that elevated serum phosphorus significantly increased all-cause mortality risk among men (RR 133; 95% CI 1.11-1.60), but not in women (RR 1.09; 95% CI 0.89-133). Conclusions: Elevated serum phosphorus concentration is independently associated with excessive risk of cardiovascular and all-cause mortality in the general population without chronic kidney disease. Serum phosphorus on all-cause mortality risk appears to be pronounced in men but exhibits no clear effect on women. However, gender difference of elevated serum phosphorus on mortality risk should be verified by more prospective studies. (C) 2016 Elsevier B.V. All rights reserved.