J Clin Neurol.  2020 Jan;16(1):29-36. 10.3988/jcn.2020.16.1.29.

Plasma Fibroblast Growth Factor 23 Concentration Is Associated with Intracranial Cerebral Atherosclerosis in Acute Ischemic Stroke Patients

  • 1Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea. knstar@ewha.ac.kr
  • 2Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
  • 5Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.


AND PURPOSE: Fibroblast growth factor 23 (FGF23) is associated with atherosclerosis via nitric-oxide-associated endothelial dysfunction and calcium-phosphate-related bone mineralization. This study aimed to determine the association of the plasma FGF23 concentration with intracranial cerebral atherosclerosis (ICAS) and extracranial cerebral atherosclerosis (ECAS).
We prospectively enrolled 262 first-ever ischemic stroke patients in whom brain magnetic resonance was performed and a blood sample acquired within 24 h after admission. Plasma FGF23 concentrations were measured using an enzyme-linked immunosorbent assay. The presence of ICAS or ECAS was defined as a ≥50% decrease in arterial diameter in magnetic resonance angiography. The burden of cerebral atherosclerosis was calculated by adding the total number of vessels defined as ICAS or ECAS.
Our study population included 152 (58.0%) males. The mean age was 64.7 years, and the plasma FGF23 concentration was 347.5±549.6 pg/mL (mean±SD). ICAS only, ECAS only, and both ICAS and ECAS were present in 31.2% (n=82), 4.9% (n=13), and 6.8% (n=18) of the subjects, respectively. In multivariate binary and ordinal logistic analyses, after adjusting for sex, age, and variables for which p < 0.1 in the univariate analysis, the plasma FGF23 concentration (per 100 pg/mL) was positively correlated with the presence of ICAS [odds ratio (OR)=1.07, 95% CI=1.00-1.15, p=0.039], burden of ICAS (OR=1.09, 95% CI=1.04-1.15, p=0.001), and burden of ECAS (OR=1.06, 95% CI=1.00-1.12, p=0.038), but it was not significantly related to the presence of ECAS (OR=1.05, 95% CI=0.99-1.12, p=0.073).
The plasma FGF23 may be a potential biomarker for cerebral atherosclerosis, particularly the presence and burden of ICAS in stroke patients.


fibroblast growth factor 23; Klotho; cerebral atherosclerosis; intracranial atherosclerosis
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