Processed meat, serum phosphate and cardiovascular risk Panniyammakal Jeemon, University of Glasgow 29 May 2013 I commend Micha et al. for their commentary on "processing of meats and cardiovascular risk". However, I would like to highlight one of the important point that they missed in their commentary. A number of observational studies have demonstrated a significant association between higher serum phosphate and adverse cardiovascular (CV) events. This association was present even within the normal range of serum phosphate and in young adults. There is also significant association between higher serum phosphate and all cause and CV mortality in hypertensive individuals with normal or mild impairment of kidney function (personal communication). Environmental factors such as increased dietary intake of protein rich and processed foods are important determinants of serum phosphate levels at the population level. Intake of phosphate rich foods is likely to be higher in deprived groups and therefore deprivation could act as a confounder or effect modifier in the association between intake of processed meat, serum phosphate and cardiovascular risk. The role of serum phosphate needs to be considered while considering the association between processed meat and CV risk. Competing interests I declare that I have no competing interests to declare. I am currently supported by a Wellcome Trust capacity building strategic grant to the Public Health Foundation of India and a consortium of United Kingdom Universities.