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Martín Navarro JA, Medina Zahonero L, Procaccini FL, Barba Teba R, Rubio Menendez V, Valle Alvarez E, PoloCánovas ME, Ortega-Díaz M, Puerta Carretero M, Lucena Valverde R, Muñoz Ramos P, Alcázar Arroyo R, de Sequera Ortiz P. Hyperaldosteronism and hyperparathyroidism. A disturbing friendship. Nefrologia 2024:S2013-2514(24)00159-7. [PMID: 39107222 DOI: 10.1016/j.nefroe.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 08/09/2024] Open
Abstract
Classically, aldosterone actions are associated with the stability of the effective circulating volume and with blood pressure control, while parathormone actions are linked to bone mineral metabolism, calcium, and phosphate homeostasis. Nevertheless, the relationship between these two hormonal axes surpasses these areas. A bidirectional interrelation between calcium-phosphorus metabolism and blood pressure control can lead to alterations in both. This can have significant implications for the evolution and treatment of patients. To illustrate this relationship, we present two clinical cases that demonstrate the pathophysiology involved.).
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Affiliation(s)
| | | | - Fabio L Procaccini
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain.
| | - Raquel Barba Teba
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain.
| | | | | | | | - Mayra Ortega-Díaz
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain.
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Verheyen N, Schmid J, Kolesnik E, Schwegel N, Späth J, Kattnig L, Riepl H, Zach D, Santner V, Höller V, Pilz S, Tomaschitz A, Fuchsjäger M, Fahrleitner‐Pammer A, Dimai HP, Obermayer‐Pietsch B, Fruhwald F, Scherr D, Zirlik A, von Lewinski D, Ablasser K. Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction. ESC Heart Fail 2024; 11:1730-1738. [PMID: 38450879 PMCID: PMC11098648 DOI: 10.1002/ehf2.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/28/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS Chronic heart failure is associated with a bone-catabolic state and increases the risk of osteoporosis and fractures. Prospective studies investigating the clinical relevance of bone disease in heart failure are lacking. We aimed to assess the prevalence and prognostic impact of osteoporosis and vertebral fractures (VFs) in chronic heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS Symptomatic outpatients with chronic heart failure and a previous diagnosis of overtly reduced left ventricular ejection fraction < 40% on stable, optimal HFrEF therapy and left ventricular ejection fraction < 50% at enrolment were included into a prospective single-centre study. Osteoporosis was determined with dual-energy X-ray absorptiometry and defined as a T-score ≤ 2.5 at any site. VFs were assessed using X-ray of both thoracic and lumbar spine applying the semiquantitative Genant score. We enrolled 205 patients (22% women), with a median age of 66 (IQR 58-74) years. Median left ventricular ejection fraction was 37 (IQR 30-43) % and median N-terminal pro B-type natriuretic peptide was 964 (IQR 363-2173) pg/mL. Osteoporosis, as defined by bone mineral density, and at least one VF were prevalent in 31 (15%) and 29 patients (14%). Osteoporosis or VF were present in 55 patients (27%) and 5 patients (2%) had both osteoporosis and a VF. During a median follow-up of 4.7 (IQR 4.0-5.3) years, 18 patients (9%) died due to cardiovascular (CV) cause, and 46 patients (22%) had a worsening heart failure (WHF) hospitalization. In multivariate Cox regression analyses, presence of VF independently predicted CV death (HR 2.82, 95% CI 1.04-7.65, P = 0.042), WHF hospitalizations (HR 2.39, 95% CI 1.18-4.82, P = 0.015), and a composite endpoint of CV death and WHF hospitalizations (HR 2.44, 95% CI 1.23-4.82, P = 0.011). Osteoporosis was not significantly associated with CV events. CONCLUSIONS In a prospective study, bone disease affected every fourth patient with HFrEF, and patients with VF at baseline had a two-fold risk of subsequent CV death or WHF hospitalization. Prevalent bone disease, particularly VF, should be considered as a clinically relevant comorbidity in HFrEF.
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Affiliation(s)
- Nicolas Verheyen
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Johannes Schmid
- Department of Radiology, Division of General RadiologyMedical University of GrazGrazAustria
| | - Ewald Kolesnik
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Nora Schwegel
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Johannes Späth
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Lydia Kattnig
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
- Department of Paediatrics and Adolescent MedicineState Hospital Hochsteiermark ‐ LeobenLeobenAustria
| | - Hermann Riepl
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - David Zach
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Viktoria Santner
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Viktoria Höller
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Stefan Pilz
- Department of Internal Medicine, Division of Diabetology and EndocrinologyMedical University of GrazGrazAustria
| | | | - Michael Fuchsjäger
- Department of Radiology, Division of General RadiologyMedical University of GrazGrazAustria
| | - Astrid Fahrleitner‐Pammer
- Department of Internal Medicine, Division of Diabetology and EndocrinologyMedical University of GrazGrazAustria
| | - Hans Peter Dimai
- Department of Internal Medicine, Division of Diabetology and EndocrinologyMedical University of GrazGrazAustria
| | - Barbara Obermayer‐Pietsch
- Department of Internal Medicine, Division of Diabetology and EndocrinologyMedical University of GrazGrazAustria
| | - Friedrich Fruhwald
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Daniel Scherr
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Andreas Zirlik
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Dirk von Lewinski
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
| | - Klemens Ablasser
- Department of Internal Medicine, Division of Cardiology, University Heart CenterMedical University of GrazGrazAustria
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Mitsuno R, Kaneko K, Nakamura T, Kojima D, Mizutani Y, Azegami T, Yamaguchi S, Yamada Y, Jinzaki M, Kinouchi K, Yoshino J, Hayashi K. Association Between Renal Sinus Fat and Cardiometabolic and Renin-Angiotensin System Parameters in Primary Aldosteronism. J Endocr Soc 2023; 8:bvad154. [PMID: 38116128 PMCID: PMC10729860 DOI: 10.1210/jendso/bvad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Indexed: 12/21/2023] Open
Abstract
Context Renal sinus fat (RSF) accumulation is associated with cardiometabolic diseases, such as obesity, diabetes, hypertension, and chronic kidney disease. However, clinical implications of RSF in primary aldosteronism (PA) remain unclear. Objective We aimed to investigate relationships between RSF volume and key cardiometabolic and renin-angiotensin system (RAS) parameters in PA patients and clarify the differences in these relationships between unilateral and bilateral subtypes. Methods We analyzed data obtained from well-characterized PA patients that involved 45 unilateral (median age: 52 years; 42.2% men) and 92 bilateral patients (51 years; 42.4% men). Results RSF volume normalized by renal volume (RSF%) was greater in the unilateral group than in the bilateral group (P < .05). RSF% was greater in men than in women (P < .05). RSF% positively correlated with parameters related to cardiometabolic risk, including age, body mass index, visceral fat volume, creatinine, triglycerides/high-density lipoprotein cholesterol ratio, uric acid, fasting glucose, and C-reactive protein regardless of PA subtypes (all P < .05). Intriguingly, RSF% positively correlated with plasma aldosterone concentration (PAC), aldosterone-to-renin ratio, and intact parathyroid hormone (iPTH) (all P < .05) in bilateral patients but did not correlate with RAS parameters and even showed an opposite trend in unilateral patients. In subgroup analyses by sex, these distinctions became more evident in women. After adjustment for potential confounders, RSF% remained positively correlated with PAC and iPTH in bilateral patients. Conclusion Our results indicate that RSF accumulation is involved in cardiometabolic dysfunction associated with PA. However, there were distinct correlations between RSF volume and RAS parameters according to sex and PA subtypes.
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Affiliation(s)
- Ryunosuke Mitsuno
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kenji Kaneko
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Toshifumi Nakamura
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Daiki Kojima
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yosuke Mizutani
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tatsuhiko Azegami
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shintaro Yamaguchi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kenichiro Kinouchi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Jun Yoshino
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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Araujo-Castro M, Pascual-Corrales E, Fernández-Argüeso M, Bengoa-Rojano N, García Cano A, Jiménez Mendiguchía L, Cuesta M. The prevalence of primary and secondary hyperparathyroidism and its cardiometabolic implications in primary aldosteronism. Minerva Endocrinol (Torino) 2023; 48:401-410. [PMID: 37166400 DOI: 10.23736/s2724-6507.23.03866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The aim of this study was to analyze the prevalence of primary and secondary hyperparathyroidism in patients with primary aldosteronism (PA), and its implication on cardiovascular and metabolic outcomes. METHODS A retrospective study of patients with PA (exposed cohort, N.=44) and all hypertensive (EH) patients with adrenal lesions without PA nor other adrenal hypersecretion (non-exposed cohort, N.=41) on follow-up at our center between 2016 and 2020. RESULTS The mean age of patients with PA and EH was 55.1±14.13 and 66.3±10.93 (P<0.001), and 50% of PA and 39.0% of EH were women (P=0.309). At diagnosis, the prevalence of primary hyperparathyroidism in PA was of 18.2%, and all were normocalcemic hyperparathyroidism cases. Globally, no differences were found in the prevalence of primary hyperparathyroidism compared to EH (18.2% vs. 29.3%, P=0.229), but hypercalcemic primary hyperparathyroidism was significantly more prevalent in EH patients than in PA (22.0% vs. 0%, P=0.001). There were 47.7% (N.=21) cases of secondary hyperparathyroidism in patients with PA (4 due to chronic kidney disease (CKD) and vitamin D deficiency, and 17 due to vitamin D deficiency alone). The cardiometabolic profile of patients with PA and hyperparathyroidism (N.=29) was similar to of those patients without hyperparathyroidism (N.=15) at diagnosis and after a median follow-up of 3.6 years (interquartile range 1.1-5.9). CONCLUSIONS Although primary and secondary hyperparathyroidism are common in patients with PA, their prevalence was similar than the observed in EH patients. Primary hyperparathyroidism is usually mild in PA, appearing as normocalcemic forms. No negative implications of the hyperparathyroidism in the cardiometabolic profile of PA were observed.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital (RCUH), Madrid, Spain -
- Ramón y Cajal Biomedical Research Institute (IRYCIS), Madrid, Spain -
| | - Eider Pascual-Corrales
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital (RCUH), Madrid, Spain
| | - María Fernández-Argüeso
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital (RCUH), Madrid, Spain
| | - Nuria Bengoa-Rojano
- Department of Endocrinology and Nutrition, Ramón y Cajal University Hospital (RCUH), Madrid, Spain
| | - Ana García Cano
- Department of Biochemistry, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Martín Cuesta
- Department of Endocrinology and Nutrition, Clínico San Carlos Hospital, Madrid, Spain
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Karwacka I, Kmieć P, Kaniuka-Jakubowska S, Pisowodzka I, Fijałkowski M, Sworczak K. Improvement of hypertension control and left-ventricular function after cure of primary hyperparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1163877. [PMID: 37492200 PMCID: PMC10364630 DOI: 10.3389/fendo.2023.1163877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Cardiovascular mortality is significantly higher in patients with primary hyperparathyroidism (PHPT) compared to the general population. The role of the renin-angiotensin-aldosterone system (RAAS) as a mediator of cardiovascular pathology in PHPT is unclear, as is the question whether successful parathyroidectomy (PTX) mitigates hypertension (HT), and left-ventricular (LV) dysfunction. Methods In 45 consecutive, hypercalcemic PHPT patients (91% female, 20 normotensive, mean age 54.6 ± 14.6), laboratory examinations, and 24 h ambulatory blood pressure monitoring (ABPM) were performed before, one and six months after successful PTX, while transthoracic echocardiography (TTE) pre- and six months post-PTX. Results Both in patients with normotension (NT) and HT, lower calcemia and parathyroid hormone (PTH) as well as higher phosphatemia were observed on follow-up, while B-type natriuretic peptide, aldosterone, plasma renin activity, and aldosterone-to-renin ratios were comparable. Six months post-PTX, only in patients with HT, median 24-hour SBP/DBP decreased by 12/6 mmHg, daytime SBP by 10, and nighttime DBP by 5 mmHg. Improvement in BP was observed in approximately 78% of patients with HT. Six months post-PTX, TTE revealed: 1) decrease in median LV mass index (by 2 g/m2) and end-diastolic dimension (by 3 mm) among patients with HT; 2) normalization of global longitudinal strain in 22% of patients (comparable between those with NT and HT); 3) a mean 12.7% reduction in left-atrium volume index among patients with HT, which underlay normalization of indeterminate diastolic function in 3 out of 6 patients with HT, who exhibited it at baseline (dysfunction persisted in 2). Conclusions PTX was shown to significantly reduce BP, LV hypertrophy and diastolic dysfunction parameters in PHPT patients with HT, and improve systolic function in all PHPT patients.
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Affiliation(s)
- Izabela Karwacka
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Kmieć
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Izabela Pisowodzka
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Parksook WW, Heydarpour M, Brown JM, Turchin A, Mannstadt M, Vaidya A. Evaluating the clinical and mechanistic effects of eplerenone and amiloride monotherapy, and combination therapy with cinacalcet, in primary hyperparathyroidism: A placebo-controlled randomized trial. Clin Endocrinol (Oxf) 2023; 98:516-526. [PMID: 36316798 PMCID: PMC10006290 DOI: 10.1111/cen.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/23/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Human physiology and epidemiology studies have demonstrated complex interactions between the renin-angiotensin-aldosterone system, parathyroid hormone and calcium homeostasis. Several of these studies have suggested that aldosterone inhibition may lower parathyroid hormone (PTH) levels. The objective of this study was to assess the effect of 4 weeks of maximally tolerated mineralocorticoid receptor antagonist therapy with eplerenone on PTH levels in patients with primary hyperparathyroidism (P-HPT) when compared to amiloride and placebo. We also investigated the synergistic effect of these interventions when combined with cinacalcet for an additional 2 weeks. DESIGN Randomized, double-blinded, three parallel-group, placebo-controlled trial. PATIENTS Patients with P-HPT. RESULTS Most patients were women (83%) and White (76%). Maximally tolerated doses of eplerenone and amiloride induced significant reductions in blood pressure and increases in renin and aldosterone production; however, despite these physiologic changes, neither intervention induced significant changes in PTH or calcium levels when compared to the placebo. Both eplerenone and amiloride therapy induced significant reductions in procollagen type 1 N-terminal propeptide levels when compared to placebo. When cinacalcet therapy was added, PTH and calcium levels were markedly reduced in all groups; however, there was no significant difference in PTH or serum calcium reductions between groups. CONCLUSIONS Although maximally tolerated therapy with eplerenone and amiloride induced expected changes in renin, aldosterone and blood pressure, there were no meaningful changes in PTH or serum calcium levels in P-HPT patients. These results suggest that inhibition of aldosterone action does not have a clinically meaningful role in medical therapy for P-HPT.
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Affiliation(s)
- Wasita W. Parksook
- Center for Adrenal Disorders, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Division of Endocrinology and Metabolism, and Division of General Internal Medicine), Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Mahyar Heydarpour
- Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA
| | - Jenifer M. Brown
- Center for Adrenal Disorders, Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Turchin
- Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Modica R, Liccardi A, Minotta R, Benevento E, Cannavale G, Colao A. Parathyroid diseases and metabolic syndrome. J Endocrinol Invest 2023; 46:1065-1077. [PMID: 36773188 DOI: 10.1007/s40618-023-02018-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Parathyroid diseases are related to parathyroid hormone (PTH) dysregulation by parathyroid cells or alteration of PTH function. They include hyperparathyroidism (PTH excess), hypoparathyroidism (PTH deficiency) and pseudohypoparathyroidism (PTH resistance). Little is known about correlation between parathyroid diseases and metabolic syndrome (MetS). METHODS An electronic-based search using PubMed was performed until October 2022 and articles were selected based on relevance of title, abstract, English language and publication in peer-reviewed journals. RESULTS Possible association between PTH alterations and the diverse manifestation of MetS have been proposed and it could be supposed that MetS may negatively influence parathyroid diseases. Available data show significant association for hyperparathyroidism and pseudohypoparathyroidism. CONCLUSIONS This review highlights the possible implications between MetS and parathyroid diseases. Given the increasing MetS global prevalence and the higher parathyroid diseases awareness and diagnosis, it may be interesting to further explore the possible role of alterations in parathyroid homeostasis in the development of MetS components with dedicated prospective studies.
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Affiliation(s)
- R Modica
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy.
| | - A Liccardi
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - R Minotta
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - E Benevento
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - G Cannavale
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Federico II University of Naples, 80131, Naples, Italy
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Renke G, Starling-Soares B, Baesso T, Petronio R, Aguiar D, Paes R. Effects of Vitamin D on Cardiovascular Risk and Oxidative Stress. Nutrients 2023; 15:nu15030769. [PMID: 36771474 PMCID: PMC9920542 DOI: 10.3390/nu15030769] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Vitamin D has been primarily studied as an important factor influencing bone and calcium metabolism. Metabolites of vitamin D are essential for whole-body calcium homeostasis, maintaining serum calcium levels within a narrow range by regulating this process in the bones and gut. Nevertheless, its deficiency is also related to increased risk of type 2 diabetes mellitus (T2DM), metabolic syndrome (MS), and cardiovascular disease (CVD)-with increased visceral adipose tissue and body mass index (BMI), as well as the frequently associated hypercholesterolemia. It has been reported that vitamin D levels are inversely related to cardiovascular (CV) risk in men and women. However, the effects of vitamin D on distinct outcomes in women and the dose of supplementation needed to improve clinical endpoints have not been established. 25-Hydroxyvitamin D [25(OH)D] reduces systemic inflammatory mediators in CVD and favors the release of anti-inflammatory cytokines from the immune system. In addition, 25(OH)D can be primarily converted into calcitriol (1,25-dihydroxycholecalciferol [1,25(OH)2D]) in the kidneys through the action of the 1-α-hydroxylase enzyme. Calcitriol, through the downregulation mechanism of renin expression, renin-angiotensin-aldosterone system (RAAS) activity, and its interaction with the vitamin D receptor, can bring CV benefits. The calcitriol form also lowers parathyroid hormone (PTH) levels by indirectly causing a reduction in aldosterone and mineralocorticoid synthesis. Elevated plasma aldosterone is related to endothelial dysfunction and CVD in hypovitaminosis D status. CONCLUSION Vitamin D supplementation may benefit certain risk groups, as it improves metabolic variables, reducing oxidative stress and CV outcomes. More studies are needed to define interventions with vitamin D in men and women.
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Affiliation(s)
- Guilherme Renke
- National Institute of Cardiology, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22640-100, Brazil
- Correspondence: ; Tel.: +55-2197-6959-339
| | | | - Thomaz Baesso
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22640-100, Brazil
| | - Rayssa Petronio
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22640-100, Brazil
| | - Danilo Aguiar
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22640-100, Brazil
| | - Raphaela Paes
- Nutrindo Ideais Performance and Nutrition Research Center, Rio de Janeiro 22640-100, Brazil
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Nägele MP, Barthelmes J, Kreysing L, Haider T, Nebunu D, Ruschitzka F, Sudano I, Flammer AJ. Endocrine hormone imbalance in heart failure with reduced ejection fraction: A cross-sectional study. Health Sci Rep 2022; 5:e880. [PMID: 36320653 PMCID: PMC9616169 DOI: 10.1002/hsr2.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/04/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aims Sustained neurohormonal activation plays a central role in the progression of heart failure (HF). Other endocrine axes may also be affected. It was the aim of this study to examine the endocrine profile (thyroid, parathyroid, glucocorticoid, and sex hormones) in a contemporary sample of patients with HF and reduced ejection fraction (EF) on established disease-modifying therapy. Methods This study prospectively measured morning fasting hormones in 52 ambulatory and stable HF patients with EF < 50% on disease-modifying therapy (mean age 63 ± 11 years, 29% female, mean LVEF 32 ± 9.6%) and compared them to 54 patients at elevated risk for HF (61 ± 12 years, 28% female) and 62 healthy controls (HC; 61 ± 13 years, 27% female). Main comparisons were performed using one-way analysis of variance. Associations with biomarkers were studied with linear regression. Results HF patients showed a reduced free triiodothyronine (fT3)/free thyroxine (fT4) ratio compared to HC (0.30 ± 0.06 vs. 0.33 ± 0.05, p = 0.046). Parathyroid hormone (PTH) and cortisol were increased in HF compared to both HC (median [IQR] 59 [50-84] vs. 46 [37-52] ng/L, p < 0.001 and 497 ± 150 vs. 436 ± 108 nmol/L, p = 0.03, respectively) and patients at risk (both p < 0.001). Total testosterone was reduced in male HF compared to HC (14.4 ± 6.6 vs. 18.6 ± 5.3 nmol/L; p = 0.01). No differences in TSH, estradiol, progesterone, and prolactin were found. Lower fT3 levels were found in HF with EF < 40% versus EF 40%-49% (4.6 ± 0.3 vs. 5.2 ± 0.7 pmol/L, p = 0.009). In HF patients, fT3 was an independent predictor of NT-proBNP and high-sensitivity troponin T in multiple regression analysis. PTH was positively associated with NT-proBNP. Conclusion There is evidence of endocrine hormonal imbalance in HF with reduced EF beyond principal neurohormones and despite the use of disease-modifying therapy.
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Affiliation(s)
- Matthias P. Nägele
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Jens Barthelmes
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Leonie Kreysing
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Thomas Haider
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Delia Nebunu
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Frank Ruschitzka
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Isabella Sudano
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
| | - Andreas J. Flammer
- CardiologyUniversity Heart Center Zurich, University Hospital ZurichZurichSwitzerland
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Wang S, Xu L, Wu Y, Shen H, Lin Z, Fang Y, Zhang L, Shen B, Liu Y, Wu K. Parathyroid Hormone Promotes Human Umbilical Vein Endothelial Cell Migration and Proliferation Through Orai1-Mediated Calcium Signaling. Front Cardiovasc Med 2022; 9:844671. [PMID: 35369318 PMCID: PMC8965836 DOI: 10.3389/fcvm.2022.844671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Parathyroid hormone is the main endocrine regulator of extracellular calcium and phosphorus levels. Secondary hyperparathyroidism–induced endothelial dysfunction may be related to calcium homeostasis disorders. Here, we investigated the effects of parathyroid hormone on human umbilical vein endothelial cells (HUVECs) and characterized the involvement of store-operated Ca2+ entry (SOCE) and the nuclear factor of activated T cells (NFAT) signaling pathway. We used immunoblot experiments to find that parathyroid hormone significantly enhanced the expression of the Orai1 channel, a type of channel mediating SOCE, SOCE activity, and Orai1-mediated proliferation of HUVECs but did not increase Orai2 and Orai3. RNA-seq was utilized to identify 1,655 differentially expressed genes (823 upregulated and 832 downregulated) in parathyroid hormone–treated HUVECs as well as enhanced focal adhesion signaling and expression levels of two key genes, namely, COL1A1 and NFATC1. Increased protein and mRNA expression levels of COL1A1 and NFATC1 were confirmed by immunoblotting and quantitative RT-PCR, respectively. Cytosol and nuclei fractionation experiments and immunofluorescence methods were used to show that parathyroid hormone treatment increased NFATC1 nuclear translocation, which was inhibited by a calcineurin inhibitor (CsA), a selective calmodulin antagonist (W7), an Orai channel inhibitor (BTP2), or Orai1 small interfering RNA (siRNA) transfection. Parathyroid hormone also increased COL1A1 expression, cell migration, and proliferation of HUVECs. The PTH-induced increase in HUVEC migration and proliferation were inhibited by CsA, W7, BTP2, or COL1A1 siRNA transfection. These findings indicated that PTH increased Orai1 expression and Orai1-mediated SOCE, causing the nuclear translocation of NFATC1 to increase COL1A1 expression and COL1A1-mediated HUVEC migration and proliferation. These results suggest potential key therapeutic targets of Orai1 and the downstream calmodulin/calcineurin/NFATC1/COL1A1 signaling pathway in parathyroid hormone–induced endothelial dysfunction and shed light on underlying mechanisms that may be altered to prevent or treat secondary hyperparathyroidism–associated cardiovascular disease.
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Affiliation(s)
- Shuhao Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lijie Xu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yv Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Otorhinolaryngology, General Hospital of Anhui Wanbei Coal Power Group, Suzhou, China
| | - Hailong Shen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhangying Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Fang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Lesha Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Bing Shen
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Yehai Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Yehai Liu
| | - Kaile Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Kaile Wu
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11
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Gravvanis C, Papanastasiou L, Glycofridi S, Voulgaris N, Tyfoxylou E, Theodora K, Piaditis G, Markou Α. Hyperparathyroidism in patients with overt and mild primary aldosteronism. Hormones (Athens) 2021; 20:793-802. [PMID: 34524646 DOI: 10.1007/s42000-021-00319-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increased prevalence of hyperparathyroidism (HP) has been observed in primary aldosteronism (PA) patients. However, HP prevalence in milder forms of PA has not to date been evaluated. OBJECTIVES The objectives of this study were to assess the prevalence of primary and secondary HP in overt and milder misdiagnosed cases of PA and to investigate the effect of treatment on parathormone (PTH) secretion. PATIENTS AND METHODS Seventy PA patients with normal renal function were included prospectively. Specifically, patients with biochemically overt PA (increased basal aldosterone/renin ratio (ARR) and a positive diagnostic suppression test (DCVT)) and patients with mild PA (normal basal ARR and a positive DCVT) were analyzed. Mean blood pressure and mineral metabolism were evaluated at diagnosis and after treatment. RESULTS Primary and secondary HP were found in 4.3% (3/70) and 51.4% (36/70) of patients, respectively, and biochemically overt and mild PA in 47.1% (33/70) and 52.9% (37/70) of patients, respectively. Sixty-three PA patients were followed up after treatment without receiving calcium or vitamin D. There was a decrease of mean blood pressure (p < 0.001), PTH (p < 0.001), and 24-h urinary calcium (p < 0.001), and an increase of serum potassium (p < 0.001) and calcium (p = 0.018) levels in secondary HP patients. There was no significant difference between biochemically overt and mild PA patients as concerned serum PTH, calcium, and 25-hydroxyvitamin-D levels either before or after treatment. Aldosterone levels before treatment were positively correlated with serum PTH levels. CONCLUSIONS HP prevalence was high in both overt and mild PA patients, whereas the effect of treatment on serum and urinary calcium and PTH levels was similar in both groups.
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Affiliation(s)
- Christos Gravvanis
- Unit of Endocrinology and Diabetes Centre, General Hospital of Athens "G Gennimatas", 154 Mesogeion Avenue, 11527, Athens, Greece.
| | - Labrini Papanastasiou
- Unit of Endocrinology and Diabetes Centre, General Hospital of Athens "G Gennimatas", 154 Mesogeion Avenue, 11527, Athens, Greece
| | - Spiridoula Glycofridi
- Unit of Endocrinology and Diabetes Centre, General Hospital of Athens "G Gennimatas", 154 Mesogeion Avenue, 11527, Athens, Greece
| | - Nikos Voulgaris
- Department of Endocrinology, Athens Naval & Veterans Hospital, Athens, Greece
| | - Ernestini Tyfoxylou
- Department of Endocrinology, 401 General Army Hospital Athens, Athens, Greece
| | - Kounadi Theodora
- Unit of Endocrinology and Diabetes Centre, General Hospital of Athens "G Gennimatas", 154 Mesogeion Avenue, 11527, Athens, Greece
| | - George Piaditis
- Department of Endocrinology, Henry Dunant Hospital Center, Athens, Greece
| | - Αthina Markou
- Unit of Endocrinology and Diabetes Centre, General Hospital of Athens "G Gennimatas", 154 Mesogeion Avenue, 11527, Athens, Greece
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12
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Combined associations of 25-hydroxivitamin D and parathyroid hormone with diabetes risk and associated comorbidities among U.S. white and black women. Nutr Diabetes 2021; 11:29. [PMID: 34531372 PMCID: PMC8676147 DOI: 10.1038/s41387-021-00171-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 08/08/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background/objectives There is evidence of black–white differences in vitamin D status and cardiometabolic health. This study aimed to further evaluate the joint associations of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) with risks of diabetes and related cardiometabolic comorbidities among white and black women. Subjects/methods We cross-sectionally and prospectively analyzed data from 1850 black and 3000 white postmenopausal women without cardiovascular disease or dialysis at baseline from the Women’s Health Initiative—Observational Study. Weighted Cox proportional hazards analyses and weighted logistic regression models were used to examine the joint associations of 25(OH)D and PTH with incident diabetes and prevalence of other diabetes-related cardiometabolic comorbidities (including CKD, hypertension, or obesity). Results We identified 3322 cases of obesity (n = 1629), hypertension (n = 2759), or CKD (n = 318) at baseline and 453 incident cases of diabetes during 11 years of follow-up. Cross-sectionally, lower 25(OH)D and higher PTH were independently associated with higher prevalence of hypertension [odds ratio (OR) = 0.79; 95% confidence interval (CI): 0.72–0.87 and OR = 1.55; 95% CI: 1.39–1.73] among white women only. When stratified by diabetes status, compared to women with 25(OH)D ≥50 nmol/L and PTH ≤6.89 pmol/L (65 pg/mL), women who did not have diabetes with vitamin D deficiency (<50 nmol/L) and PTH excess (>6.89 pmol/L) had higher prevalence of CKD, hypertension, or obesity (OR = 4.23; 95% CI: 2.90–6.18) than women who had diabetes (OR = 1.89; 95% CI: 0.96–3.71). Prospectively, lower 25(OH)D was associated with lower diabetes incidence [hazard ratio (HR) = 0.73; 95% CI: 0.62–0.86] in white women. Jointly, compared to the group with 25(OH)D ≥50 nmol/L and PTH ≤6.89 pmol/L, white women with 25(OH)D deficiency (<50 nmol/L) had elevated risk for diabetes, regardless of PTH levels. Conclusions Low 25(OH)D and high PTH were jointly associated with increased risk of diabetes among white women only. Their joint associations with high prevalence of CKD, hypertension, and obesity were more pronounced among women without diabetes.
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Oinonen L, Tikkakoski A, Koskela J, Eräranta A, Kähönen M, Niemelä O, Mustonen J, Pörsti I. Parathyroid hormone may play a role in the pathophysiology of primary hypertension. Endocr Connect 2021; 10:54-65. [PMID: 33289696 PMCID: PMC7923049 DOI: 10.1530/ec-20-0446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Parathyroid hormone has been related with the risk of hypertension, but the matter remains controversial. We examined the association of parathyroid hormone with central blood pressure and its determinants in 622 normotensive or never-treated hypertensive subjects aged 19-72 years without diabetes, cardiovascular or renal disease, or cardiovascular medications. The methods were whole-body impedance cardiography and analyses of pulse wave and heart rate variability. Cardiovascular function was examined in sex-specific tertiles of plasma parathyroid hormone (mean concentrations 3.0, 4.3 and 6.5 pmol/L, respectively) during head-up tilt. Explanatory factors for haemodynamics were further investigated using linear regression analyses. Mean age was 45.0 (s.d. 11.7) years, BMI 26.8 (4.4) kg/m2, seated office blood pressure 141/90 (21/12) mmHg, and 309 subjects (49.7%) were male. Only five participants had elevated plasma parathyroid hormone and calcium concentrations. Highest tertile of parathyroid hormone presented with higher supine and upright aortic diastolic blood pressure (P < 0.01) and augmentation index (P < 0.01), and higher upright systemic vascular resistance (P < 0.05) than the lowest tertile. The tertiles did not present with differences in pulse wave velocity, cardiac output, or measures of heart rate variability. In linear regression analyses, parathyroid hormone was an independent explanatory factor for aortic systolic (P = 0.005) and diastolic (P = 0.002) blood pressure, augmentation index (P = 0.002), and systemic vascular resistance (P = 0.031). To conclude, parathyroid hormone was directly related to central blood pressure, wave reflection, and systemic vascular resistance in subjects without cardiovascular comorbidities and medications. Thus, parathyroid hormone may play a role in the pathophysiology of primary hypertension.
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Affiliation(s)
- Lasse Oinonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Correspondence should be addressed to L Oinonen:
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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14
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Bayomy O, Zaheer S, Williams JS, Curhan G, Vaidya A. Disentangling the Relationships Between the Renin-Angiotensin-Aldosterone System, Calcium Physiology, and Risk for Kidney Stones. J Clin Endocrinol Metab 2020; 105:5803967. [PMID: 32163150 PMCID: PMC7185954 DOI: 10.1210/clinem/dgaa123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Complex relationships between aldosterone and calcium homeostasis have been proposed. OBJECTIVE To disentangle the influence of aldosterone and intravascular volume on calcium physiology. DESIGN Patient-oriented and epidemiology studies. SETTING Clinical research center and nationwide cohorts. PARTICIPANTS/INTERVENTIONS Patient-oriented study (n = 18): Participants were evaluated after completing a sodium-restricted (RES) diet to contract intravascular volume and after a liberalized-sodium (LIB) diet to expand intravascular volume. Cross-sectional studies (n = 3755): the association between 24h urinary sodium and calcium excretion and risk for kidney stones was assessed. RESULTS Patient-oriented study: compared to a RES-diet, a LIB-diet suppressed renin activity (LIB: 0.3 [0.1, 0.4] vs. RES: 3.1 [1.7, 5.3] ng/mL/h; P < 0.001) and plasma aldosterone (LIB: 2.0 [2.0, 2.7] vs. RES: 20.0 [16.1, 31.0] vs. ng/dL; P < 0.001), but increased calciuria (LIB: 238.4 ± 112.3 vs. RES: 112.9 ± 60.8 mg/24hr; P < 0.0001) and decreased serum calcium (LIB: 8.9 ± 0.3 vs. RES: 9.8 ± 0.4 mg/dL; P < 0.0001). Epidemiology study: mean urinary calcium excretion was higher with greater urinary sodium excretion. Compared to a urinary sodium excretion of < 120 mEq/day, a urinary sodium excretion of ≥220 mEq/day was associated with a higher risk for having kidney stones in women (risk ratio = 1.79 [95% confidence interval 1.05, 3.04]) and men (risk ratio = 2.06 [95% confidence interval 1.27, 3.32]). CONCLUSIONS High dietary sodium intake suppresses aldosterone, decreases serum calcium, and increases calciuria and the risk for developing kidney stones. Our findings help disentangle the influences of volume from aldosterone on calcium homeostasis and provide support for the recommendation to restrict dietary sodium for kidney stone prevention.
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Affiliation(s)
- Omar Bayomy
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
| | - Sarah Zaheer
- Division of Endocrinology and Metabolism, Department of Medicine, Duke University, Durham, NC, US
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
| | - Gary Curhan
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
| | - Anand Vaidya
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
- Correspondence and Reprint Requests: Anand Vaidya, MD MMSc, Division of Endocrinology, Diabetes, and Hypertension, 221 Longwood Ave, Boston, MA 02115. E-mail:
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15
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Rroji M, Figurek A, Spasovski G. Should We Consider the Cardiovascular System While Evaluating CKD-MBD? Toxins (Basel) 2020; 12:toxins12030140. [PMID: 32106499 PMCID: PMC7150959 DOI: 10.3390/toxins12030140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular (CV) disease is highly prevalent in the population with chronic kidney disease (CKD), where the risk of CV death in early stages far exceeds the risk of progression to dialysis. The presence of chronic kidney disease-mineral and bone disorder (CKD-MBD) has shown a strong correlation with CV events and mortality. As a non-atheromatous process, it could be partially explained why standard CV disease-modifying drugs do not provide such an impact on CV mortality in CKD as observed in the general population. We summarize the potential association of CV comorbidities with the older (parathyroid hormone, phosphate) and newer (FGF23, Klotho, sclerostin) CKD-MBD biomarkers.
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Affiliation(s)
- Merita Rroji
- University Department of Nephrology, Faculty of Medicine, University of Medicine Tirana, Tirana 1001, Albania
- Correspondence:
| | - Andreja Figurek
- Institute of Anatomy, University of Zurich, Zurich 8057, Switzerland;
| | - Goce Spasovski
- University Department of Nephrology, Medical Faculty, University of Skopje, Skopje 1000, North Macedonia;
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16
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Azzam EZ, Ata MN, Younan DN, Salem TM, Abdul-Aziz AA. DObesity: Relationship between vitamin D deficiency, obesity and sclerostin as a novel biomarker of bone metabolism. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2019; 17:100197. [PMID: 31193780 PMCID: PMC6542767 DOI: 10.1016/j.jcte.2019.100197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/28/2022]
Abstract
Aim To study the relationship between obesity, insulin resistance, vitamin D deficiency and sclerostin as a bone biomarker. Materials and methods Cross-section study of 75 subjects grouped into 3 groups; obese (n = 31), overweight (n = 23) and normal (n = 21) subjects. Sclerostin, fasting insulin, fasting plasma glucose and 25(OH)D were measured and anthropometric measures were taken. Results 25(OH)D was lower in obese subjects than overweight and control groups (mean ± SD 5.27 ± 5.14 vs. 12.55 ± 6.99 vs.17.65 ± 4.07 ng/L, p < 0.001). Sclerostin was significantly lower in obese subjects versus the control (mean ± SD 1.02 ± 0.45 vs 1.58 ± 0.83 ng/mL, p = 0.014). Conclusion These results lead us to hypothesize that the relationship between sclerostin and Vitamin D levels has an important role in the link between obesity and bone metabolism. DObesity could be an active focus of research in the coming years.
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Affiliation(s)
- Eman Zaki Azzam
- Department of Internal Medicine, Endocrinology Unit, Faculty of Medicine, University of Alexandria, Egypt
| | - Mohamed Nabil Ata
- Department of Internal Medicine, Endocrinology Unit, Faculty of Medicine, University of Alexandria, Egypt
| | - Doreen Nazeih Younan
- Department of Chemical and Clinical Pathology, Faculty of Medicine, University of Alexandria, Egypt
| | - Tarek M Salem
- Department of Internal Medicine, Endocrinology Unit, Faculty of Medicine, University of Alexandria, Egypt
| | - Ahmed Alaa Abdul-Aziz
- Department of Internal Medicine, Endocrinology Unit, Faculty of Medicine, University of Alexandria, Egypt
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Underbjerg L, Sikjaer T, Rejnmark L. Cardiovascular findings in patients with nonsurgical hypoparathyroidism and pseudohypoparathyroidism: A cohort study. Clin Endocrinol (Oxf) 2019; 90:592-600. [PMID: 30589959 DOI: 10.1111/cen.13927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE As only sparse data are available on indices of cardiovascular health among patients with nonsurgical hypoparathyroidism (Ns-HypoPT) and pseudohypoparathyroidism (PHP), we aimed to compare the cardiovascular profile between these groups of patients. METHODS A total of 56 patients with Ns-HypoPT and 30 with PHP were included and underwent a clinical examination including blood sampling and measurements of arterial stiffness, pulse wave velocity (PWV) and blood pressure (BP). Arterial stiffness and PWV were measured using AtCor SphygmoCor-XCEL (Atcor Medical Pty Ltd, Sydney, NSW, Australia). RESULTS Patients with Ns-HypoPT had an average age of 47 ± 17 years (68% females) and PHP patients 36 ± 13 years (80% females). Over 70% in both groups were genetically screened. Groups did not differ in terms of a history of cardiovascular disease, smoking status, use of calcium and vitamin D supplements or treatment with cholesterol-lowering or antihypertensive drugs. Compared with Ns-HypoPT, PHP patients had significantly lower levels of high-density lipoproteins (HDL) cholesterol and average glucose from HbA1c (Pboth = 0.01). PWV was significantly higher among patients with Ns-HypoPT (Pcrude = 0.02), even after adjustment for mean arterial pressure, body mass index, age and gender (Padjusted < 0.01). Heart rate was significantly higher in Ns-HypoPT compared with PHP (P = 0.03). Office BP and 24-hour ambulatory BP did not differ between groups (P > 0.05). CONCLUSION Patients with Ns-HypoPT have compared with PHP a higher arterial stiffness and heart rate. This has been associated with an increased risk of cardiovascular disease. Our data suggest that resistance to PTH is present in the cardiovascular system in PHP.
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Affiliation(s)
- Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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18
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Durgarao Y, Manjrekar PA, Adhikari P, Chakrapani M, Rukmini MS. Comprehensive Review on Diabetes Associated Cardiovascular Complications - The Vitamin D Perspective. Cardiovasc Hematol Disord Drug Targets 2019; 19:139-153. [PMID: 30648528 DOI: 10.2174/1871529x19666190114155302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Abstract
Vitamin D, a steroid hormone is primarily known for its role in calcium and bone mineral homeostasis. Over the years, vitamin D has been implicated in various non-skeletal diseases. The extraskeletal phenomenon can be attributed to the presence of vitamin D receptors (VDRs) in almost all cells and identification of 1-α hydroxylase in extrarenal tissues. The vitamin D deficiency (VDD) pandemic was globally reported with increasing evidence and paralleled the prevalence of diabetes, obesity and cardiovascular diseases (CVDs). A dependent link was proposed between hypovitaminosis D glycemic status, insulin resistance and also the other major factors associated with type 2 diabetes leading to CVDs. Insulin resistance plays a central role in both type 2 diabetes and insulin resistance syndrome. These 2 disorders are associated with distinct etiologies including hypertension, atherogenic dyslipidemia, and significant vascular abnormalities that could lead to endothelial dysfunction. Evidence from randomised clinical trials and meta-analysis, however, yielded conflicting results. This review summarizes the role of vitamin D in the regulation of glucose homeostasis with an emphasis on insulin resistance, blood pressure, dyslipidaemia, endothelial dysfunction and related cardiovascular diseases and also underline the plausible mechanisms for all the documented effects.
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Affiliation(s)
- Y Durgarao
- Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Poornima A Manjrekar
- Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Prabha Adhikari
- Department of Internal Medicine, Yenepoya University, Mangalore, Karnataka, India
| | - M Chakrapani
- Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - M S Rukmini
- Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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19
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Seccia TM, Caroccia B, Gomez-Sanchez EP, Gomez-Sanchez CE, Rossi GP. The Biology of Normal Zona Glomerulosa and Aldosterone-Producing Adenoma: Pathological Implications. Endocr Rev 2018; 39:1029-1056. [PMID: 30007283 PMCID: PMC6236434 DOI: 10.1210/er.2018-00060] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023]
Abstract
The identification of several germline and somatic ion channel mutations in aldosterone-producing adenomas (APAs) and detection of cell clusters that can be responsible for excess aldosterone production, as well as the isolation of autoantibodies activating the angiotensin II type 1 receptor, have rapidly advanced the understanding of the biology of primary aldosteronism (PA), particularly that of APA. Hence, the main purpose of this review is to discuss how discoveries of the last decade could affect histopathology analysis and clinical practice. The structural remodeling through development and aging of the human adrenal cortex, particularly of the zona glomerulosa, and the complex regulation of aldosterone, with emphasis on the concepts of zonation and channelopathies, will be addressed. Finally, the diagnostic workup for PA and its subtyping to optimize treatment are reviewed.
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Affiliation(s)
- Teresa M Seccia
- Department of Medicine-DIMED, University of Padua, Padua PD, Italy
| | | | - Elise P Gomez-Sanchez
- Department of Pharmacology and Toxicology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| | - Celso E Gomez-Sanchez
- Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi.,University of Mississippi Medical Center, Jackson, Mississippi
| | - Gian Paolo Rossi
- Department of Medicine-DIMED, University of Padua, Padua PD, Italy
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20
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Loh HH, Yee A, Loh HS. Bone health among patients with primary aldosteronism: a systematic review and meta-analysis. MINERVA ENDOCRINOL 2018; 44:387-396. [PMID: 30482008 DOI: 10.23736/s0391-1977.18.02867-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Recent studies showed a possible association between hyperaldosteronism and secondary hyperparathyroidism leading to reduced bone health, however results are conflicting. EVIDENCE ACQUISITION We conducted a meta-analysis to evaluate the relationship between primary aldosteronism (PA) with bone biochemical markers and to assess bone mineral density in patients with primary aldosteronism. EVIDENCE SYNTHESIS A total of 939 subjects were examined (37.5% with PA). Patients with PA had significantly higher serum parathyroid hormone, lower serum calcium, higher urine calcium excretion and higher serum alkaline phosphatase compared to patients without PA, with no significant difference in serum vitamin D between both groups. Bone mineral density of lumbar spine, femoral neck and total neck of femur were similar between two groups. With PA treatment, there was a significant increment in serum calcium and reduction in serum parathyroid hormone. CONCLUSIONS PA is associated with hypercalciuria with subsequent secondary hyperparathyroidism. This potentially affects bone health. We recommend this to be part of complication screening among patients with PA.
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Affiliation(s)
- Huai H Loh
- Faculty of Medicine and Health Sciences, University of Malaysia, Sarawak, Malaysia -
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Huai S Loh
- Clinical Academic Unit, Newcastle University Medicine Malaysia, Johor, Malaysia
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21
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Rossi GP, Prisco S. Does angiotensin II regulate parathyroid hormone secretion or not? Clin Endocrinol (Oxf) 2018; 89:568-569. [PMID: 29947100 DOI: 10.1111/cen.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Gian Paolo Rossi
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Selene Prisco
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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22
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Edmonston D, Morris JD, Middleton JP. Working Toward an Improved Understanding of Chronic Cardiorenal Syndrome Type 4. Adv Chronic Kidney Dis 2018; 25:454-467. [PMID: 30309463 DOI: 10.1053/j.ackd.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 12/17/2022]
Abstract
Chronic diseases of the heart and of the kidneys commonly coexist in individuals. Certainly combined and persistent heart and kidney failure can arise from a common pathologic insult, for example, as a consequence of poorly controlled hypertension or of severe diffuse arterial disease. However, strong evidence is emerging to suggest that cross talk exists between the heart and the kidney. Independent processes are set in motion when kidney function is chronically diminished, and these processes can have distinct adverse effects on the heart. The complex chronic heart condition that results from chronic kidney disease (CKD) has been termed cardiorenal syndrome type 4. This review will include an updated description of the cardiac morphology in patients who have CKD, an overview of the most likely CKD-sourced culprits for these cardiac changes, and the potential therapeutic strategies to limit cardiac complications in patients who have CKD.
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23
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de Albuquerque Suassuna PG, Sanders-Pinheiro H, de Paula RB. Uremic Cardiomyopathy: A New Piece in the Chronic Kidney Disease-Mineral and Bone Disorder Puzzle. Front Med (Lausanne) 2018; 5:206. [PMID: 30087898 PMCID: PMC6066558 DOI: 10.3389/fmed.2018.00206] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases are the main cause of death in chronic kidney disease (CKD) patients. In dialysis patients, sudden cardiac death accounts for 40% of all deaths. In these patients, sudden cardiac death is usually secondary to an underlying cardiomyopathy, which is clinically identified by the high prevalence of left ventricular hypertrophy and the resultant mechanical and electrical dysfunction. CKD-related cardiomyopathy has a multifactorial pathophysiology. Recent evidence has highlighted the central pathophysiological role of chronic kidney disease-mineral and bone disorder (CKD-MBD) with hyperphosphatemia and high fibroblast growth factor 23 (FGF23) levels in these patients. Further, since CKD is known to be an αKlotho deficiency state, experimental studies have demonstrated that the deleterious effects of FGF23 can be minimized by reestablishing adequate soluble Klotho levels. Herein, we present a review that addresses not only the development of the understanding of CKD-related cardiomyopathy pathophysiology, but also explores the recent data that identify the triad of hyperphosphatemia, high FGF23 levels and αKlotho deficiency as playing a central role on it. Taken together, the data suggest that the uremic cardiomyopathy can be considered a new piece in the CKD-DMO puzzle.
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Affiliation(s)
- Paulo G de Albuquerque Suassuna
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Helady Sanders-Pinheiro
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rogério B de Paula
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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24
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Fujii H. Association between Parathyroid Hormone and Cardiovascular Disease. Ther Apher Dial 2018; 22:236-241. [PMID: 29707916 DOI: 10.1111/1744-9987.12679] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/21/2018] [Accepted: 02/02/2018] [Indexed: 12/01/2022]
Abstract
Although parathyroid hormone is known to be related with calcium and phosphate metabolism, it has been also reported to have several effects on the cardiovascular system including heart and vessels. However, the detailed pathophysiological mechanisms remain unclear. Clinical studies have indicated that parathyroid hormone is associated with cardiovascular events and mortality not only in patients with chronic kidney disease but also in those without chronic kidney disease. As a possible mechanism, it is thought that parathyroid hormone is associated with the renin-angiotensin-aldosterone system and has direct effects on the cardiovascular system. Therefore, we should pay attention to not only the control of serum phosphate and calcium levels but also the control of serum parathyroid hormone levels, especially in patients with chronic kidney disease.
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Affiliation(s)
- Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
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25
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DeCarlo KE, Agrawal N. Double hit! A unique case of resistant hypertension. BMJ Case Rep 2017; 2017:bcr-2017-221530. [PMID: 29275380 DOI: 10.1136/bcr-2017-221530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosterone:renin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing. CT scan of the adrenals was non-localising. Adrenal venous sampling confirmed bilateral idiopathic adrenal hyperplasia. Concurrent primary hyperparathyroidism was demonstrated by elevated calcium and parathyroid hormone levels and localised by sestamibi scan. Idiopathic adrenal hyperplasia was treated medically with spironolactone. Her BP remained elevated until postparathyroidectomy. Evidence shows that a hyperfunctioning parathyroid gland may contribute to maintaining hyperaldosteronism in PA making this bidirectional link unique. The significance of this case is in the potential for further understanding of the pathophysiology of common causes of secondary hypertension.
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Affiliation(s)
- Kristen Elizabeth DeCarlo
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nidhi Agrawal
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, NYU School of Medicine, New York City, New York, USA
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26
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Verheyen N, Grübler MR, Meinitzer A, Trummer C, Schwetz V, Amrein K, Dimai HP, März W, Catena C, von Lewinski D, Voelkl J, Alesutan I, Fahrleitner-Pammer A, Brussee H, Pilz S, Tomaschitz A. Effect of eplerenone on markers of bone turnover in patients with primary hyperparathyroidism - The randomized, placebo-controlled EPATH trial. Bone 2017; 105:212-217. [PMID: 28918310 DOI: 10.1016/j.bone.2017.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
Mineralocorticoid receptor (MR) antagonism may affect bone turnover via direct and indirect pathways involving parathyroid hormone, but randomized controlled trials are lacking. In a pre-specified analysis of the "Eplerenone in primary hyperparathyroidism" placebo-controlled, randomized trial (ISRCTN 33941607), effects of eight weeks MR-blockade with eplerenone on bone turnover markers in 97 patients with primary hyperparathyroidism were tested. Mean age was 67.5±9.5years, and 76 (78.4%) were females. In analysis of covariance with adjustment for baseline values, eplerenone had no significant effect on isoform 5b of the tartrate-resistant acid phosphatase (TRAP), beta-crosslaps, N-terminal propeptide of procollagen type 1 (P1NP), osteocalcin and bone-specific alkaline phosphatase. There was no significant cross-sectional correlation between plasma aldosterone concentration or the aldosterone-to-renin ratio and markers of bone turnover in multivariate linear regression models at baseline. These data provide first evidence from a randomized and placebo-controlled trial that short-term MR antagonism may not affect bone turnover, at least in patients with primary hyperparathyroidism.
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Affiliation(s)
- Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria.
| | - Martin R Grübler
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria; Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, University of Bern, Switzerland
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Verena Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Hans P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Synlab Academy, Synlab Services LLC, Mannheim, Germany; Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim, Germany
| | - Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | | | - Jakob Voelkl
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Ioana Alesutan
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Helmut Brussee
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria; Department of Health Sciences and the EMGO(+) Institute, VU University Amsterdam, The Netherlands
| | - Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Graz, Austria; Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim, Germany; Bad Gleichenberg Clinic, Bad Gleichenberg, Austria
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27
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Bosselmann H, Tonder N, Sölétormos G, Gaborit F, Rossing K, Iversen K, Goetze JP, Gustafsson F, Schou M. Influence of renal impairment on aldosterone status, calcium metabolism, and vasopressin activity in outpatients with systolic heart failure. ESC Heart Fail 2017; 4:554-562. [PMID: 29154425 PMCID: PMC5695175 DOI: 10.1002/ehf2.12186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/13/2016] [Accepted: 05/01/2017] [Indexed: 12/15/2022] Open
Abstract
Aims Renal dysfunction (RD) is associated with increased morbidity and mortality in heart failure (HF). At present, no specific treatment for patients with RD, to prevent progression of HF, has been developed. How different hormone axes—and thereby potential treatment options—are affected by RD in HF warrants further investigations. Methods and results Patients with left ventricular ejection fraction (LVEF) <0.45% were enrolled prospectively from an outpatient HF clinic. Glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation (eGFR), and patients were grouped by eGFR: eGFR group I, ≥90 mL/min/1.73 m2; eGFR group II, 60–89 mL/min/1.73 m2; and eGFR group III, ≤59 mL/min/1.73 m2. Multivariate linear regression models were developed to evaluate the associations between eGFR groups and hormones. A total of 149 patients participated in the study. Median age was 69 [interquartile range (IQR): 64–73] and 26% were female; LVEF was 33% (IQR: 27–39), 78% were in functional class II–III, median eGFR was 74 (54–89) mL/min/1.73 m2, and median N‐terminal pro‐brain natriuretic peptide was 1303 pg/mL (IQR: 441–2740). RD was associated with increased aldosterone, parathyroid hormone (PTH), and copeptin concentrations (P < 0.05 for all) after adjustment for traditional confounders and medical treatment. Conclusions RD is associated with increased concentrations of aldosterone, PTH, and copeptin in systolic HF outpatients. Our results underscore the importance of treatment with mineralocorticoid receptor antagonist in systolic HF in particular in patients with RD and suggest that vasopressin and parathyroid receptor antagonism are potential treatment options in HF patients with known RD.
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Affiliation(s)
- Helle Bosselmann
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2141, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Cardiology, Nephrology and Endocrinology, Northzealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels Tonder
- Department of Cardiology, Nephrology and Endocrinology, Northzealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - György Sölétormos
- Department of Clinical Biochemistry, Northzealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Freja Gaborit
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2141, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2141, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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28
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Lee YH, Kweon SS, Choi JS, Nam HS, Park KS, Choi SW, Ryu SY, Oh SH, Shin MH. Association of serum vitamin D and parathyroid hormone with subclinical atherosclerotic phenotypes: The Dong-gu Study. PLoS One 2017; 12:e0186421. [PMID: 29088221 PMCID: PMC5663373 DOI: 10.1371/journal.pone.0186421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background Although previous studies reported an association between serum vitamin D and parathyroid hormone (PTH) with carotid atherosclerosis or arterial stiffness, these were inconsistent. We examined the independent association between serum vitamin D and PTH with multiple subclinical markers of atherosclerosis. Methods A total of 8,217 subjects who participated in the Dong-gu Study in Korea were included in the final analysis. The carotid artery structure, including intima-media thickness (IMT), plaques, and luminal diameter, was evaluated using a high-resolution B-mode ultrasound. The brachial-ankle pulse wave velocity (baPWV) was determined using an automatic waveform analysis device, and the mean of the left and right baPWV was used. Results The PTH concentration was positively associated with carotid luminal diameter and baPWV, but not with carotid IMT and plaques. The mean carotid luminal diameter of individuals with PTH levels in the second, third, and fourth quartiles was significantly larger compared with those in the first quartile (P-trend < 0.01). The mean baPWV of individuals with PTH levels in the fourth quartile was significantly greater than those with PTH levels in the first quartile (P-trend = 0.01). However, there was no significant association between vitamin D and any atherosclerotic phenotypes, including carotid IMT, plaques, luminal diameter, and baPWV. Conclusion This suggests that PTH might affect the development of atherosclerosis by altering vascular compliance.
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Affiliation(s)
- Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Jeonbuk, Republic of Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Jin-Su Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Kyeong-Soo Park
- Department of Preventive Medicine, Seonam University College of Medicine, Namwon, Jeonbuk, Republic of Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Republic of Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Republic of Korea
| | - Su-Hyun Oh
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Republic of Korea
- * E-mail:
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29
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Yugar-Toledo JC, Modolo R, de Faria AP, Moreno H. Managing resistant hypertension: focus on mineralocorticoid-receptor antagonists. Vasc Health Risk Manag 2017; 13:403-411. [PMID: 29081661 PMCID: PMC5652936 DOI: 10.2147/vhrm.s138599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mineralocorticoid-receptor antagonists (MRAs) have proven to be effective in some types of hypertension, especially in resistant hypertension (RHTN). In this phenotype of hypertension, the renin-angiotensin-aldosterone pathway plays an important role, with MRAs being especially effective in reducing blood pressure. In this review, we show the relevance of aldosterone in RHTN, as well as some clinical characteristics of this condition and the main concepts involving its pathophysiology and cardiovascular damage. We analyzed the mechanisms of action and clinical effects of two current MRAs - spironolactone and eplerenone - both of which are useful in RHTN, with special attention to the former. RHTN represents a significant minority (10%-15%) of hypertension cases. However, primary-care physicians, cardiologists, nephrologists, neurologists, and geriatricians face this health problem on a daily basis. MRAs are likely one of the best pharmacological options in RHTN patients; however, they are still underused.
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Affiliation(s)
| | - Rodrigo Modolo
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana Paula de Faria
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Heitor Moreno
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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30
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Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism: the eplerenone in primary hyperparathyroidism trial. J Hypertens 2017; 34:1778-86. [PMID: 27379537 DOI: 10.1097/hjh.0000000000001004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients. METHODS Cross-sectional data of the single-center "Eplerenone in Primary Hyperparathyroidism" trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included. RESULTS Full data were available in 136 patients (mean age 67 ± 10 years, 78% women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ± 0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted β-coefficient = 0.289, P < 0.01; DBP: β = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml. CONCLUSION ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.
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31
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Christopoulou EC, Filippatos TD, Megapanou E, Elisaf MS, Liamis G. Phosphate imbalance in patients with heart failure. Heart Fail Rev 2017; 22:349-356. [DOI: 10.1007/s10741-017-9615-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Qi D, Nie XL, Wu S, Cai J. Vitamin D and hypertension: Prospective study and meta-analysis. PLoS One 2017; 12:e0174298. [PMID: 28358827 PMCID: PMC5373576 DOI: 10.1371/journal.pone.0174298] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/07/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The study sought to determine the link between vitamin D concentrations and incident hypertension in prospective study and meta-analysis. METHODS The study was embedded in the Kailuan Study, a population-based cohort of adults that contains underground miners. In 2012, we studied 2,456 men and women free of prevalent hypertension, age 21 to 67 at baseline. Serum 25-hydroxyvitamin D was measured from previously frozen baseline samples using ELISA (Enzyme-Linked ImmunoadSorbent Assay). We use the logistic regression analysis to estimate the odd radio (ORs) 95% confidence intervals (CIs) for 25-hydroxyvitamin D [25(OH)D] concentrations with incident hypertension. To help place our new data in context, we conducted a systemic review and meta-analysis of previous prospective reports of vitamin D and hypertension. RESULTS During a median follow-up of 2 years, 42.6% of the cohort (n = 1047) developed hypertension. Compared with the 25-hydroxyvitamin D >30ng/ml, 25-hydroxyvitamin D <20 ng/ml was associated with a greater hypertension risk (OR: 1.225 [95% CI: 1.010 to 1.485] p = 0.04), although the association was attenuated and not statistically significant after adjusting for potential confounders (OR: 1.092 [95% CI: 0.866 to 1.377] p = 0.456). This meta-analysis included seven prospective studies for 53,375 participants using adjusted HR founded a significant association between vitamin D deficiencies and incident hypertension (HRs = 1.235 (95% CI: 1.083 to 1.409, p = 0.002)). CONCLUSION Lower serum 25-hydroxyvitamin D concentrations were not associated with a greater risk of incident hypertension. More research is needed to further determine the role of 25-hydroxyvitamin D in hypertension prevention and therapy.
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Affiliation(s)
- Dan Qi
- The Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-lu Nie
- Children’s Hospital, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology. Kailuan Hospital, North China University of Science and Technology, Tangshan, China
- * E-mail: (JC); (SW)
| | - Jun Cai
- Professor, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (JC); (SW)
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Loncar G, Bozic B, Cvetinovic N, Dungen HD, Lainscak M, von Haehling S, Doehner W, Radojicic Z, Putnikovic B, Trippel T, Popovic V. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 2017; 40:297-304. [PMID: 27738907 DOI: 10.1007/s40618-016-0561-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 01/06/2023]
Abstract
AIM Evaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF). METHODS Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up. RESULTS SHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p < 0.0001), left ventricular ejection fraction (27 ± 8 vs. 31 ± 7 %, p = 0.019), and NT-proBNP [2452 (3399) vs. 918 (1372) pg/ml, p < 0.0001]. No differences in age, vitamin D status, and renal function were noted between studied groups. A total of 41 (56 %) patients died within 6 years of follow-up. Kaplan-Meier survival analysis showed impaired long-term survival in patients with SHPT versus patients with normal PTH (p = 0.009). The rate of death was highest (75 %) in the group of patients with SHPT and NT-proBNP levels above median value (p = 0.003). Cox regression analysis demonstrated that NT-proBNP was the single independent predictor of all-cause mortality at 6-year follow-up [HR 3.698 (1.927-7.095), p < 0.0001]. CONCLUSION SHPT was highly prevalent in elderly males with HF and was associated with impaired survival. HF patients with SHPT had more severe disease compared to the patients with normal serum PTH. Determination of serum PTH levels provided additional value to NT-proBNP for risk stratification in these patients.
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Affiliation(s)
- G Loncar
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - B Bozic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
- Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia
| | - N Cvetinovic
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia
| | - H-D Dungen
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Lainscak
- Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - S von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charite University Medical School, Berlin, Germany
| | - Z Radojicic
- Institute for Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - B Putnikovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - T Trippel
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - V Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
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Al-khalidi B, Kimball SM, Rotondi MA, Ardern CI. Standardized serum 25-hydroxyvitamin D concentrations are inversely associated with cardiometabolic disease in U.S. adults: a cross-sectional analysis of NHANES, 2001-2010. Nutr J 2017; 16:16. [PMID: 28241878 PMCID: PMC5329954 DOI: 10.1186/s12937-017-0237-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Previously reported associations between vitamin D status, as measured by serum 25-hydroxyvitamin D [25(OH)D] concentrations, and cardiometabolic risk factors were largely limited by variability in 25(OH)D assay performance. In accordance with the Vitamin D Standardization Program, serum 25(OH)D measurement was recently standardized in the National Health and Nutrition Examination Survey (NHANES) to reduce laboratory and method related differences in serum 25(OH)D results. We evaluated the overall and ethnic-specific associations between the newly standardized serum 25(OH)D concentrations and cardiometabolic risk in U.S. adults. METHODS This study examined standardized 25(OH)D data from five cycles of the NHANES (2001-2010). The total sample included 7674 participants (1794 Mexican-Americans, 4289 non-Hispanic whites, and 1591 non-Hispanic blacks) aged ≥ 20 years who were examined in the morning after overnight fasting. Serum 25(OH)D was directly measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 2007-2010, and was predicted from LC-MS/MS equivalents for 2001-2006. Serum 25(OH)D levels were categorized into quartiles (<43.4, 43.4-58.6, 58.7-74.2, ≥74.3 nmol/L). Cardiometabolic risk was defined by the homeostatic model assessment of insulin resistance (HOMA-IR), metabolic syndrome (MetS), and Framingham cardiovascular disease (CVD) risk. Prevalence ratios and 95% confidence intervals were calculated using modified Poisson regression. RESULTS After full adjustment for confounders, serum 25(OH)D ≥74.3 nmol/L was associated with lower cardiometabolic risk compared to 25(OH)D <43.4 nmol/L in the overall sample [HOMA-IR: 0.70 (0.59, 0.84); MetS: 0.82 (0.74, 0.91); CVD risk: 0.78 (0.66, 0.91)]. These associations remained significant in Mexican-Americans [HOMA-IR: 0.54 (0.35, 0.82); MetS: 0.73 (0.55, 0.96)], non-Hispanic whites [HOMA-IR: 0.81 (0.68, 0.96); MetS: 0.84 (0.73, 0.95); CVD risk: 0.78 (0.64, 0.93)]; and in non-Hispanic blacks [HOMA-IR: 0.67 (0.45, 0.99); MetS: 0.75 (0.56, 0.97); CVD risk: 0.58 (0.41, 0.81)]. CONCLUSIONS Low vitamin D status is a significant risk factor for cardiometabolic disease in U.S. adults based on standardized serum 25(OH)D results, irrespective of ethnic background. Future studies using standardized 25(OH)D data are needed to confirm these results, particularly amongst U.S. blacks with 25(OH)D concentrations above 75 nmol/L.
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Affiliation(s)
- Banaz Al-khalidi
- School of Kinesiology and Heath Science, York University, Toronto, M3J1P3 ON Canada
| | | | - Michael A. Rotondi
- School of Kinesiology and Heath Science, York University, Toronto, M3J1P3 ON Canada
| | - Chris I. Ardern
- School of Kinesiology and Heath Science, York University, Toronto, M3J1P3 ON Canada
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Dysfunctional immunometabolic effects of vitamin D deficiency, increased cardiometabolic risk. Potential epidemiological alert in America? ACTA ACUST UNITED AC 2017; 64:162-173. [PMID: 28440755 DOI: 10.1016/j.endinu.2016.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/01/2016] [Accepted: 11/18/2016] [Indexed: 12/22/2022]
Abstract
Vitamin D deficiency is a serious public health problem worldwide that affects not only skeletal health, but also a wide range of acute and chronic diseases. However, there is still skepticism because of the lack of randomized, controlled trials to support association studies on the benefits of vitamin D for non-skeletal health. This review was based on articles published during the 1980-2015 obtained from the Cochrane Central Register of controlled trials, MEDLINE and PubMed, and focuses on recent challenges with regard to the definition of vitamin D deficiency and how to achieve optimal serum 25-hydroxyvitamin D levels from dietary sources, supplements, and sun exposure. The effect of vitamin D on epigenetic fetal programming and regulation of genes that may potentially explain why vitamin D could have such lifelong comprehensive health benefits is reviewed. Optimization of vitamin D levels in children and adults around the world has potential benefits to improve skeletal health and to reduce the risk of chronic diseases, including some types of cancer, autoimmune diseases, infectious diseases, type 2 diabetes mellitus, and severe cardiovascular disorders such as atherothrombosis, neurocognitive disorders, and mortality.
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Elseweidy MM, Zein N, Aldhamy SE, Elsawy MM, Saeid SA. Policosanol as a new inhibitor candidate for vascular calcification in diabetic hyperlipidemic rats. Exp Biol Med (Maywood) 2016; 241:1943-1949. [PMID: 27460718 PMCID: PMC5068461 DOI: 10.1177/1535370216659943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
This work mainly aimed to investigate the probable changes of aortic calcification by policosanol, omega-3 fatty acids in comparison with atorvastatin and subsequent progression of atherosclerosis in diabetic hyperlipemic rat model. Adult male albino rats of wistar strain (30) were divided into five groups (n = 6/group); one was fed normal diet and was used as a normal group, the other groups received alloxan, atherogenic diet (CCT - rat chow diet supplemented with 4% cholesterol, 1% cholic acid, and 0.5% thiouracil) and categorized as follows: the second group received no treatment and kept as control (diabetic hyperlipidemic control group (DHC)). The other groups received daily oral doses of atorvastatin, policosanol (10 mg/kg body weight) and ω-3 (50 mg/kg body weight), respectively, for eight weeks. Different biomarkers were used for the evaluation that included inflammatory (C reactive protein (CRP), tumor necrosis factor α (TNF-α)), oxidative stress (glutathione (GSH), malondialdehyde (MDA)) bone calcification markers (alkaline phosphatase (ALP), Vitamin D, parathyroid hormone (PTH)), lipogram pattern in addition to histochemical demonstration of calcium in the aorta. Diabetic hyperlipemic group demonstrated significant hyperglycemia, hyperlipidemia, and increased inflammation, oxidative stress, calcification, and finally atherogenesis progression. Treatment of diabetic hyperlipemic rats with, policosanol, omega-3 fatty acids (natural products) and atorvastatin for eight weeks significantly increased high-density lipoprotein cholesterol (HDL-C), Vitamin D, decreased aortic vacuoles number, and inhibited calcification process. Policosanol induced more remarkable reduction in the density and number of foam cells and improved the intimal lesions of the aorta as compared to atorvastatin. Drugs under study exerted hypoglycemic effect along with an inhibition of inflammation, oxidative stress, and calcium deposition with certain variations but policosanol effect was remarkable in comparison with other drugs.
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Affiliation(s)
- Mohamed M Elseweidy
- Biochemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Nabila Zein
- Biochemistry Department, Faculty of Science, Zagazig University, Zagazig 44519, Egypt
| | - Samih E Aldhamy
- Pharmacognosy Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Marwa M Elsawy
- Biochemistry Department, Faculty of Science, Zagazig University, Zagazig 44519, Egypt
| | - Saeid A Saeid
- Chemistry Department, Faculty of Science, Zagazig University, Zagazig 44519, Egypt
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Stowasser M, Gordon RD. Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney. Physiol Rev 2016; 96:1327-84. [DOI: 10.1152/physrev.00026.2015] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the 60 years that have passed since the discovery of the mineralocorticoid hormone aldosterone, much has been learned about its synthesis (both adrenal and extra-adrenal), regulation (by renin-angiotensin II, potassium, adrenocorticotrophin, and other factors), and effects (on both epithelial and nonepithelial tissues). Once thought to be rare, primary aldosteronism (PA, in which aldosterone secretion by the adrenal is excessive and autonomous of its principal regulator, angiotensin II) is now known to be the most common specifically treatable and potentially curable form of hypertension, with most patients lacking the clinical feature of hypokalemia, the presence of which was previously considered to be necessary to warrant further efforts towards confirming a diagnosis of PA. This, and the appreciation that aldosterone excess leads to adverse cardiovascular, renal, central nervous, and psychological effects, that are at least partly independent of its effects on blood pressure, have had a profound influence on raising clinical and research interest in PA. Such research on patients with PA has, in turn, furthered knowledge regarding aldosterone synthesis, regulation, and effects. This review summarizes current progress in our understanding of the physiology of aldosterone, and towards defining the causes (including genetic bases), epidemiology, outcomes, and clinical approaches to diagnostic workup (including screening, diagnostic confirmation, and subtype differentiation) and treatment of PA.
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Affiliation(s)
- Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - Richard D. Gordon
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Limited data exist on the vitamin D status in Fontan patients. We determined the prevalence and potential risk factors of vitamin D deficiency in this patient subset. Methods and results Data were collected from 27 Fontan patients (55.6% male, mean age 8.1±5.3 years). Protein-losing enteropathy was diagnosed in six patients (22.2%). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D level of <20 ng/ml. The neutrophil-to-lymphocyte ratio, a marker of systemic inflammation, was calculated. Associations between laboratory measurements and patient characteristics were explored. Mean serum 25-hydroxyvitamin D level was 14.1±10.4 ng/ml. Vitamin D deficiency was found in 19/27 patients (70.3%). Only skin type was associated with vitamin D deficiency (p=0.04). Hyperparathyroidism was present in 5/21 (23.8%) patients, and was more prevalent in patients with protein-losing enteropathy (p<0.001). Parathyroid hormone levels correlated with parameters of systemic inflammation (neutrophil-to-lymphocyte ratio: r=0.484, p=0.026; relative lymphocyte count: r=-0.635, p=0.002). Vitamin D supplementation significantly increased serum 25-hydroxyvitamin D levels (p<0.0001), and was accompanied by a reduction in parathyroid hormone concentrations (p=0.032). CONCLUSIONS A high prevalence of vitamin D deficiency was found among Fontan patients, independent of age, time after Fontan procedure, ventricular morphology, and presence of protein-losing enteropathy. A potentially important link between parathyroid hormone levels and systemic inflammation is suggested.
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Zhang LX, Gu WJ, Li YJ, Wang Y, Wang WB, Wang AP, Shen L, Zang L, Yang GQ, Lu ZH, Dou JT, Mu YM. PTH Is a Promising Auxiliary Index for the Clinical Diagnosis of Aldosterone-Producing Adenoma. Am J Hypertens 2016; 29:575-81. [PMID: 26304960 DOI: 10.1093/ajh/hpv146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/02/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parathyroid hormone (PTH) stimulates aldosterone secretion in human adrenocortex and is regulated by the renin-angiotensin-aldosterone system. We speculated that measurement of PTH may be a valuable aid in the diagnosis of aldosterone-producing adenoma (APA). METHODS To test this hypothesis, we recruited 142 patients with adrenal adenoma, of whom 84 had an APA and 58 had a nonfunctioning adrenal adenoma (NFA). Plasma levels of intact PTH, serum potassium, sodium, calcium, phosphate, 25(OH) vitamin D, plasma aldosterone concentration (PAC), plasma renin activity (PRA), and aldosterone to renin ratio (ARR) were measured in every patient. Computed tomography (CT) scanning of the adrenal gland and adrenal hormone levels was used to evaluate the function of the adrenal adenoma. We also evaluated the impact of renin-angiotensin-aldosterone system (RAAS) components on PTH from the recumbent-upright test in 15 patients with APA and 30 patients with NFA. RESULTS Compared with NFA, PTH levels were significantly increased in patients with APA, and serum calcium and phosphate were significantly decreased. When position was changed from supine to upright, the variation in PTH levels was significantly higher in APA patients compared with NFA patients. Receiver operator characteristic (ROC) curves identified the Youden index, which corresponded to the best tradeoff of combined marker (ARR and PTH) with a sensitivity and specificity of 89.3% and 93.1%, respectively. CONCLUSIONS The baseline and positional variation of serum PTH levels were significant in APA, thus PTH may be a promising auxiliary index for the clinical diagnosis of APA.
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Affiliation(s)
- Lin-Xi Zhang
- Medical Center, Tsinghua University, Beijing, China; Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Wei-Jun Gu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yi-Jun Li
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yang Wang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Bo Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - An-Ping Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Lei Shen
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Li Zang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Guo-Qing Yang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Zhao-Hui Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Jing-Tao Dou
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yi-Ming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China;
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Abstract
PTH and Vitamin D are two major regulators of mineral metabolism. They play critical roles in the maintenance of calcium and phosphate homeostasis as well as the development and maintenance of bone health. PTH and Vitamin D form a tightly controlled feedback cycle, PTH being a major stimulator of vitamin D synthesis in the kidney while vitamin D exerts negative feedback on PTH secretion. The major function of PTH and major physiologic regulator is circulating ionized calcium. The effects of PTH on gut, kidney, and bone serve to maintain serum calcium within a tight range. PTH has a reciprocal effect on phosphate metabolism. In contrast, vitamin D has a stimulatory effect on both calcium and phosphate homeostasis, playing a key role in providing adequate mineral for normal bone formation. Both hormones act in concert with the more recently discovered FGF23 and klotho, hormones involved predominantly in phosphate metabolism, which also participate in this closely knit feedback circuit. Of great interest are recent studies demonstrating effects of both PTH and vitamin D on the cardiovascular system. Hyperparathyroidism and vitamin D deficiency have been implicated in a variety of cardiovascular disorders including hypertension, atherosclerosis, vascular calcification, and kidney failure. Both hormones have direct effects on the endothelium, heart, and other vascular structures. How these effects of PTH and vitamin D interface with the regulation of bone formation are the subject of intense investigation.
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Affiliation(s)
- Syed Jalal Khundmiri
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Physiology and Biophysics, University of Louisville, Louisville, Kentucky, USA
| | - Rebecca D. Murray
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Physiology and Biophysics, University of Louisville, Louisville, Kentucky, USA
| | - Eleanor Lederer
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Physiology and Biophysics, University of Louisville, Louisville, Kentucky, USA
- Robley Rex VA Medical Center, University of Louisville, Louisville, Kentucky, USA
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Baser H, Cuhaci N, Topaloglu O, Yulek F, Ugurlu N, Ersoy R, Cagil N, Cakir B. Is there any association between primary hyperparathyroidism and ocular changes, such as central corneal thickness, retinal thickness, and intraocular pressure? Endocrine 2016; 51:545-50. [PMID: 26318316 DOI: 10.1007/s12020-015-0724-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
Ocular changes are commonly encountered in various endocrine disorders. However, only a few studies have reported ocular changes in patients with primary hyperparathyroidism (PHPT). Here, we examined the central corneal thickness (CCT), retinal thickness (RT), and intraocular pressure (IOP), and their relationships with serum intact parathyroid hormone (iPTH), calcium (Ca), and phosphorus (P) levels in patients with PHPT. Thirty-seven eyes of 37 PHPT patients were compared with 43 eyes of 43 age- and sex-matched normal subjects. A detailed ophthalmologic examination, including CCT, RT, and IOP, was performed. CCT and IOP in PHPT patients were significantly higher than controls (p = 0.024 and p = 0.038, respectively). No statistically significant difference was detected in RT between the two groups (p = 0.730). iPTH levels were positively correlated with CCT and IOP (r = 0.304, p = 0.006 and r = 0.249, p = 0.026, respectively). No significant correlation was found between iPTH levels and RT (p > 0.05), and between serum Ca levels, and RT, CCT, and IOP (all, p > 0.05). While there was a negative correlation between serum P levels and CCT (r = -0.264, p = 0.018), no correlation was observed between serum P levels, and RT and IOP (both, p > 0.05). Using multiple regression analyses, iPTH, serum Ca, and serum P levels were found to have no significant associations with CCT, IOP, and RT (all, p > 0.05). There was no significant association between PHPT, and CCT, RT, and IOP. We postulate that the identification of ocular aspects of PHPT is significant, and further studies related to this condition are required.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ankara, Turkey.
- , Ovecler, 1297 Sokak, No. 1/22, 06460, Ankara, Turkey.
| | - Neslihan Cuhaci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Fatma Yulek
- Department of Ophthalmology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Nagihan Ugurlu
- Department of Ophthalmology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Nurullah Cagil
- Department of Ophthalmology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Farolfi A, Ferrario C, Aquilina M, Cecconetto L, Tartaglia A, Ibrahim T, Serra L, Oboldi D, Nizzoli M, Rocca A. Paraneoplastic hypocalcemia-induced heart failure in advanced breast cancer: A case report and literature review. Oncol Lett 2015; 10:773-777. [PMID: 26622568 PMCID: PMC4509413 DOI: 10.3892/ol.2015.3326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 05/07/2015] [Indexed: 12/18/2022] Open
Abstract
Hypocalcemia is an uncommon clinical symptom of patients with malignant tumors, and a number of factors may be involved in its development. The present study describes the case of a 67-year-old Caucasian female, presenting with severe refractory hypocalcemia and heart failure. The patient was subsequently diagnosed with breast cancer and bone metastases. The paraneoplastic origin of the syndrome was confirmed by its complete resolution once the tumor responded to specific antineoplastic treatments, comprising weekly paclitaxel and aromatase inhibitor administration. The present case report suggested the need for greater awareness of the possibility of paraneoplastic hypocalcemia in breast cancer patients, and suggested that this condition may also contribute to the occurrence of heart failure. The mechanisms potentially responsible for this event were discussed and a brief review of the literature presented.
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Affiliation(s)
- Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy
| | - Cristiano Ferrario
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy
| | - Michele Aquilina
- Cardiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy
| | - Lorenzo Cecconetto
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy
| | - Andreas Tartaglia
- Endocrinology and Metabolism Unit, Morgagni-Pierantoni Hospital, 47121 Forlì (FC), Italy
| | - Toni Ibrahim
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy
| | - Luigi Serra
- Pathology Unit, Morgagni-Pierantoni Hospital, 47121 Forlì (FC), Italy
| | - Devil Oboldi
- Radiology Unit, IRST IRCCS, 47014 Meldola (FC), Italy
| | - Maurizio Nizzoli
- Endocrinology and Metabolism Unit, Morgagni-Pierantoni Hospital, 47121 Forlì (FC), Italy
| | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy
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Gruson D, Ferracin B, Ahn SA, Zierold C, Blocki F, Hawkins DM, Bonelli F, Rousseau MF. 1,25-Dihydroxyvitamin D to PTH(1-84) Ratios Strongly Predict Cardiovascular Death in Heart Failure. PLoS One 2015; 10:e0135427. [PMID: 26308451 PMCID: PMC4550259 DOI: 10.1371/journal.pone.0135427] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Vitamin D deficiency and hyperparathyroidism are common in patients with heart failure (HF). There is a growing body of evidence supporting the role of vitamin D and parathyroid hormone (PTH) in cardiac remodeling and worsening of HF. Lack of reliable automated testing of 1,25-dihydroxyvitamin D (1,25(OH)2D), the biologically active metabolite of vitamin D, has limited its contribution to the prognostic assessment of HF. Here, the association of 1,25(OH)2D and PTH(1-84) levels was evaluated for prediction of cardiovascular death in chronic HF patients. METHODS We conducted a single center prospective cohort including 170 chronic HF patients (females n = 36; males n = 134; NYHA II-IV; mean age: 67 years; etiology: ischemic n = 119, dilated cardiomyopathy n = 51; mean LVEF: 23%). The primary outcome was cardiovascular death. RESULTS Serum levels of 1,25(OH)2D decreased markedly with increased HF severity. Medians were 33.3 pg/mL for NYHA-II patients, 23.4 pg/mL for NYHA-III, and 14.0 pg/mL for NYHA-IV patients (p<0.001). Most patients had levels of 25(OH)D below 30ng/mL, and stratification by NYHA functional class did not show significant differences (p = 0.249). The 1,25(OH)2D to PTH(1-84) ratio and the (1,25(OH)2D)2 to PTH(1-84) ratio were found to be the most significantly related to HF severity. After a median follow-up of 4.1 years, 106 out of 170 patients reached the primary endpoint. Cox proportional hazard modeling revealed 1,25(OH)2D and the 1,25(OH)2D to PTH(1-84) ratios to be strongly predictive of outcomes. CONCLUSIONS 1,25(OH)2D and its ratios to PTH(1-84) strongly and independently predict cardiovascular mortality in chronic HF.
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Affiliation(s)
- Damien Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Ferracin
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Sylvie A. Ahn
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Claudia Zierold
- DiaSorin Inc, 1951 Northwestern Avenue, Stillwater, Minnesota, 55082, United States of America
| | - Frank Blocki
- DiaSorin Inc, 1951 Northwestern Avenue, Stillwater, Minnesota, 55082, United States of America
| | - Douglas M. Hawkins
- School of Statistics, University of Minnesota, Minneapolis, Minnesota, 55455, United States of America
| | - Fabrizio Bonelli
- DiaSorin Inc, 1951 Northwestern Avenue, Stillwater, Minnesota, 55082, United States of America
| | - Michel F. Rousseau
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma. Case Rep Endocrinol 2015; 2015:910984. [PMID: 26161274 PMCID: PMC4487930 DOI: 10.1155/2015/910984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 12/19/2022] Open
Abstract
Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%). Coexistence of different endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental left adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1 mg/dL), high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30), compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm. The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.
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Vaidya A, Curhan GC, Paik JM, Kronenberg H, Taylor EN. Hypertension, Antihypertensive Medications, and Risk of Incident Primary Hyperparathyroidism. J Clin Endocrinol Metab 2015; 100:2396-404. [PMID: 25885946 PMCID: PMC4454810 DOI: 10.1210/jc.2015-1619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Hypertension is associated with higher PTH levels, and specific antihypertensive medications may modulate PTH. Whether hypertension or the use of specific antihypertensive medications influences the risk of developing incident primary hyperparathyroidism (P-HPTH) is not known. OBJECTIVE The purpose of this study was to investigate whether a history of hypertension and the use of specific antihypertensive medications determine the risk for developing P-HPTH in a large prospective study. DESIGN/PARTICIPANTS A longitudinal prospective cohort of female nurses in the Nurses' Health Study I (n = 75 600), who did not have P-HPTH at baseline and completed a questionnaire assessment of lifetime history of P-HPTH were followed from 1986 to 2008. Most participants were white and postmenopausal. SETTING The study was a nationwide cohort study. MAIN OUTCOME MEASURE Incident P-HPTH was assessed initially via questionnaire and then was confirmed by medical record review. Cox proportional hazards models were used to adjust for potential confounders. RESULTS We documented 347 incident cases of P-HPTH during 1 719 416 person-years of follow-up. The age-adjusted relative risk (RR) for incident P-HPTH associated with hypertension was 1.80 (95% confidence interval [CI], 1.43-2.26), and the multivariate-adjusted RR was 1.45 (95% CI, 1.10-1.91). Among participants with a history of hypertension, the use of furosemide, when compared with the use of other antihypertensive medications, was associated with increased risk for developing P-HPTH; age-adjusted RR for incident P-HPTH was 1.79 (95% CI, 1.15-2.79) and multivariate-adjusted RR was 1.71 (95% CI, 1.08-2.71). CONCLUSIONS In a large longitudinal prospective cohort study of mostly older white women, a history of hypertension and use of furosemide were associated with a significantly higher risk of developing P-HPTH.
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Affiliation(s)
- Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Gary C Curhan
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Julie M Paik
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Henry Kronenberg
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Eric N Taylor
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
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Nakada Y, Takahama H, Kanzaki H, Sugano Y, Hasegawa T, Ohara T, Amaki M, Funada A, Yoshida A, Yasuda S, Ogawa H, Anzai T. The predictability of renin–angiotensin–aldosterone system factors for clinical outcome in patients with acute decompensated heart failure. Heart Vessels 2015; 31:925-31. [DOI: 10.1007/s00380-015-0688-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
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48
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Estimation of the cutoff value of vitamin D: the Dong-gu study. J Physiol Anthropol 2015; 34:10. [PMID: 25858328 PMCID: PMC4359542 DOI: 10.1186/s40101-015-0048-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/13/2015] [Indexed: 01/27/2023] Open
Abstract
Background Vitamin D plays an essential role in bone health and growth, but the optimal serum 25-hydroxyvitamin D (25(OH)D) concentration is not known. This study was performed to investigate the optimal 25(OH)D concentration in regard to parathyroid hormone (PTH) concentration in the Korean general population aged 50 years or older. Findings The study population consisted of 8,857 subjects (3,545 men and 5,312 women) who participated in the baseline survey of the Dong-gu study, conducted in Korea between 2007 and 2010. Serum 25(OH)D and PTH concentrations were measured by chemiluminescent microparticle immunoassay. The optimal 25(OH)D concentration was estimated by using nonlinear regression model. Our data show that PTH concentration reached a theoretical plateau at 38.2 pg/ml and corresponding 25(OH)D concentration was 21.1 ng/ml in men and PTH concentration at 42.9 pg/ml and 25(OH)D concentration at 13.8 ng/ml in women. Conclusions These results indicate that, for Korean general population aged 50 years or older, the optimal 25(OH)D concentration is 21.1 ng/ml in men and 13.8 ng/ml in women.
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Tomaschitz A, Pilz S, Rus-Machan J, Meinitzer A, Brandenburg VM, Scharnagl H, Kapl M, Grammer T, Ritz E, Horina JH, Kleber ME, Pieske B, Kraigher-Krainer E, Hartaigh BÓ, Toplak H, van Ballegooijen AJ, Amrein K, Fahrleitner-Pammer A, März W. Interrelated aldosterone and parathyroid hormone mutually modify cardiovascular mortality risk. Int J Cardiol 2015; 184:710-716. [PMID: 25777071 DOI: 10.1016/j.ijcard.2015.03.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/19/2015] [Accepted: 03/03/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Inappropriate aldosterone and parathyroid hormone (PTH) secretion is associated with increased cardiovascular risk. Accumulating evidence suggests bidirectional interplay between aldosterone and PTH. METHODS We evaluated the cross-sectional relationship between plasma aldosterone concentration (PAC), aldosterone to renin ratio (ARR) and PTH and subsequently tested whether the interaction between PAC and PTH modified the risk of cardiovascular death. PAC [78.0 (48.0-123.0) pg/mL], ARR [6.4 (2.9-12.9) pg/mL/pg/mL] and PTH concentration [median: 29.0 (22.0-40.0) pg/mL] were measured in 3074 patients (mean age: 62.5 ± 10.6 years; 30.3% women) referred to coronary angiography in a tertiary care center in Southwest Germany. RESULTS Using multiple linear regression analysis, PAC and ARR emerged as an independent predictor of higher PTH concentrations (β=0.12 and 0.21, P<0.001 for both) irrespective of intake of antihypertensive treatment, 25(OH)D, kidney function, serum calcium, phosphate, magnesium, cortisol, NT-pro-BNP, soluble α-klotho and FGF-23 concentration. After a median follow-up of 9.9 years, 512 (16.7%) participants had died due to fatal cardiovascular events. Multivariate Cox proportional hazard analysis revealed that both PAC and PTH were independently associated with cardiovascular mortality, with a potential synergistic interaction (P=0.028). PAC and PTH are exclusively associated with cardiovascular death in subjects with PTH and PAC concentrations above the median, respectively (PAC: HR per log SD: 1.14; 95% CI 1.02-1.29; P=0.026; PTH: HR per log SD: 1.18; 95% CI 1.02-1.37; P=0.031). CONCLUSIONS Higher PAC and ARR were independently associated with PTH. PAC was independently related to incident cardiovascular mortality exclusively in patients with elevated PTH and vice versa.
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Affiliation(s)
- Andreas Tomaschitz
- Specialist Clinic for Rehabilitation Bad Aussee, Bad Aussee, Austria; Department of Cardiology, Medical University of Graz, Graz, Austria; Department of Internal Medicine - Cardiology, Charité University Hospital Berlin, Campus Virchow Klinikum, Berlin Germany.
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria; Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands.
| | - Jutta Rus-Machan
- Specialist Clinic for Rehabilitation Bad Aussee, Bad Aussee, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | | | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Martin Kapl
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Tanja Grammer
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Eberhard Ritz
- University Hospital Heidelberg, Department of Medicine, Division of Nephrology, Heidelberg, Germany
| | - Jörg H Horina
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Burkert Pieske
- Department of Cardiology, Medical University of Graz, Graz, Austria; Department of Internal Medicine - Cardiology, Charité University Hospital Berlin, Campus Virchow Klinikum, Berlin Germany
| | - Elisabeth Kraigher-Krainer
- Department of Cardiology, Medical University of Graz, Graz, Austria; Department of Internal Medicine - Cardiology, Charité University Hospital Berlin, Campus Virchow Klinikum, Berlin Germany
| | - Bríain Ó Hartaigh
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, USA; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, USA
| | - Hermann Toplak
- Department of Internal Medicine, Diabetes and Metabolism, Medical University of Graz, Austria
| | - Adriana J van Ballegooijen
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Synlab Academy, Synlab Services LLC, Mannheim, Germany
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Zhang S, Hu Y, Zhou L, Chen X, Wang Y, Wu J, He H, Gao Y. Correlations between serum intact parathyroid hormone (PTH) and N-terminal-probrain natriuretic peptide levels in elderly patients with chronic heart failure (CHF). Arch Gerontol Geriatr 2015; 60:359-65. [DOI: 10.1016/j.archger.2014.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/16/2014] [Accepted: 11/18/2014] [Indexed: 01/18/2023]
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