Observational studies in general populations have found a higher risk of myocardial infarction, stroke, and heart failure in the order of 40% per 20 pg/ml higher FGF-23 concentration (about 1-SD in general populations).12,41,42 Used within the available outcome datasets in this report, our FGF-23 genetic instrument was estimated to have 80% power to detect true higher odds of cardiovascular diseases in the order of 5%–15%. This evidence concerns the gene FGF23 and heart failure.