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However, increasing clinical and experimental evidence indicates that alterations in phosphate homoeostasis could have an even stronger impact on the heart.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this review is to provide the reader with an update of how alterations in mineral metabolism are related to direct and indirect cardiotoxic effects beyond the nephrology setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Evidence exists that alterations in mineral metabolism that are related to changes in parathyroid hormone (<jats:styled-content style=\"fixed-case\">PTH<\/jats:styled-content>), vitamin D, and the <jats:styled-content style=\"fixed-case\">FGF<\/jats:styled-content>\u201023\u2013klotho axis have direct pathological consequences for the heart. Alterations in plasma <jats:styled-content style=\"fixed-case\">PTH<\/jats:styled-content> levels are associated with cardiac dysfunction and detrimental cardiac remodelling. Several clinical studies have associated vitamin D deficiency with the prevalence of cardiovascular disease (<jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content>) and its risk factors. Recent evidences support deleterious direct and nonphosphaturic effects of <jats:styled-content style=\"fixed-case\">FGF<\/jats:styled-content>\u201023 on the heart as hypertrophy development. In contrast, reduced systemic klotho levels are related to <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> damage, at least when advanced age is present. In addition, we discuss how these mineral metabolism molecules can counteract each other in some situations, in the context of failed clinical trials on cardiac protection as is the case of vitamin D supplementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among all mineral components, an increase in systemic <jats:styled-content style=\"fixed-case\">FGF<\/jats:styled-content>\u201023 levels is considered to have the greatest <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> impact and risk. However, it is quite possible that many intracellular mechanisms mediated by <jats:styled-content style=\"fixed-case\">FGF<\/jats:styled-content>\u201023, especially those related to cardiomyocyte function, remain to be discovered.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.12902","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T19:06:43Z","timestamp":1517598403000},"source":"Crossref","is-referenced-by-count":54,"title":["<scp>PTH<\/scp>, vitamin D, and the <scp>FGF<\/scp>\u201023\u2013klotho axis and heart: Going beyond the confines of nephrology"],"prefix":"10.1111","volume":"48","author":[{"given":"Jos\u00e9 Alberto","family":"Navarro\u2010Garc\u00eda","sequence":"first","affiliation":[{"name":"Cardiorenal Translational Laboratory Institute of Research i+12 Hospital Universitario de Octubre\/CIBERCV Madrid 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