Why would serum phosphorus correlate with cardiovascular risk, and how is the clinician supposed to use this information?

Numerous recent studies have demonstrated an association between serum phosphorus and cardiovascular risk, even in individuals with normal kidney function and with serum phosphorus levels considered within the acceptable range. Whether serum phosphorus serves as a biomarker, as a causative agent, or both remains unclear. Additionally, the impact of other important considerations, such as the time of day when the phosphorus is measured, the diet of the individual, and the age of the individual, on interpretation of this association has not been determined. Currently, serum phosphorus cannot be used systematically as an independent cardiovascular risk factor but may be an important adjunctive factor in analyzing cardiovascular risk. More importantly, understanding the basis for the association between serum phosphorus and cardiovascular risk will likely yield new insights into fundamental mechanisms of cardiovascular disease.