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Kong SK, Tsai MC, Yeh CL, Tsai YC, Chien MN, Lee CC, Tsai WH. Association between primary hyperparathyroidism and cardiovascular outcomes: A systematic review and meta-analysis. Bone 2024; 185:117130. [PMID: 38795811 DOI: 10.1016/j.bone.2024.117130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Excess parathyroid hormone (PTH) is associated with an increased risk of cardiovascular disease (CVD). PURPOSE We aimed to evaluate the correlation between primary hyperparathyroidism (PHPT) and CVD or cardiovascular (CV) death. DATA SOURCES Comprehensive searches of PubMed, Embase and ClinicalTrials.gov until May 20, 2023 with the following keywords: "primary hyperparathyroidism," "cardiovascular disease," and "mortality." STUDY SELECTIONS Cohort studies and randomized controlled trials comparing PHPT patients to the general population and those who had received parathyroidectomy (PTX) to those who did not. DATA EXTRACTION Three investigators independently extracted data and assessed study quality. DATA SYNTHESIS Eleven cohort studies and one randomized controlled trial were identified, including 264,227 PHPT patients with or without PTX, and the average age reported in the studies was 62 years. PHPT was associated with a higher risk of total death (RR 1.39 [95 % confidence interval (CI) 1.23-1.57) and CV death (RR 1.61 [95 % CI 1.47-1.78]) than the general population. However, there was no significant difference in CVD risk between patients with PHPT and the general population (RR 1.73 [95 % CI 0.87-3.47]). When compared to patients without PTX, PTX had a lower risk of CV death (RR 0.75 [95 % CI 0.71-0.80]), total death (RR 0.64 [95 % CI 0.60-0.70]) and CVD (RR 0.92 [95 % CI 0.90-0.94]). LIMITATION High heterogeneity among the included articles, and most of them were retrospective and older studies. CONCLUSIONS PHPT was associated with higher risk of total death and CV death while PTX was associated with lower risk of total death, CV death, and CVD.
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Affiliation(s)
- Siang-Ke Kong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan
| | - Ming-Chieh Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 104, Taiwan
| | - Chun-Lin Yeh
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Yu-Cheng Tsai
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Ming-Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Wen-Hsuan Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan.
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Scicchitano P, Iacoviello M, Passantino A, Gesualdo M, Trotta F, Basile M, De Palo M, Guida P, Paolillo C, Riccioni G, Ciccone MM, Caldarola P, Massari F. Plasma Levels of Intact Parathyroid Hormone and Congestion Burden in Heart Failure: Clinical Correlations and Prognostic Role. J Cardiovasc Dev Dis 2022; 9:jcdd9100334. [PMID: 36286286 PMCID: PMC9604445 DOI: 10.3390/jcdd9100334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Circulating parathyroid hormone (PTH) concentrations increase in heart failure (HF) and are related to disease severity. The relationship between PTH and congestion is still a matter of debate. The objective of this analysis was to evaluate the role of PTH as a marker of congestion and prognosis in HF. We enrolled 228 patients with HF. Intact PTH concentrations and HYDRA score (constituted by: B-type natriuretic peptide, blood urea nitrogen−creatinine ratio, estimated plasma volume status, and hydration status) were evaluated. The study endpoint was all-cause mortality. PTH levels were higher in acute compared with chronic HF and in patients with clinical signs of congestion (i.e., peripheral oedema and orthopnea). PTH concentrations significantly correlated with NYHA class and HYDRA score. At multivariate analysis of HYDRA score, estimated glomerular filtration rate (eGFR), and corrected serum calcium were independently determinants of PTH variability. Fifty patients (22%) died after a median follow-up of 408 days (interquartile range: 283−573). Using univariate Cox regression analysis, PTH concentrations were associated with mortality (hazard ratio [HR]: 1.003, optimal cut-off: >249 pg/mL—area under-the-curve = 0.64). Using multivariate Cox regression analysis, PTH was no longer associated with death, whereas HYDRA score, left ventricular ejection fraction, and eGFR acted as independent predictors for mortality (HR: 1.96, 0.97, and 0.98, respectively). Our study demonstrated that intact PTH was related to clinical and subclinical markers of congestion. However, intact PTH did not act as an independent determinant of all-cause death in HF patients.
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Affiliation(s)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, FG, Italy
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS Institute of Bari, 70124 Bari, BA, Italy
| | - Michele Gesualdo
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
| | - Francesco Trotta
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
| | - Marco Basile
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
| | - Micaela De Palo
- Cardiac Surgery Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy
| | - Piero Guida
- Ospedale Generale Regionale “F. Miulli”, 70021 Acquaviva delle Fonti, BA, Italy
| | - Claudio Paolillo
- Cardiology Section, Hospital “Umberto I”, 70033 Corato, BA, Italy
| | - Graziano Riccioni
- Cardiology Unit, San Camillo de Lellis, Hospital, Via Isonzo 1, 71043 Manfredonia, FG, Italy
| | - Marco Matteo Ciccone
- Cardiology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy
| | | | - Francesco Massari
- Cardiology Section, Hospital “F. Perinei”, 70022 Altamura, BA, Italy
- Correspondence:
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Ilich JZ, Liu PY, Shin H, Kim Y, Chi Y. Cardiometabolic Indices after Weight Loss with Calcium or Dairy Foods: Secondary Analyses from a Randomized Trial with Overweight/Obese Postmenopausal Women. Nutrients 2022; 14:nu14051082. [PMID: 35268057 PMCID: PMC8912560 DOI: 10.3390/nu14051082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023] Open
Abstract
The role of dairy foods and calcium/vitamin D supplements in cardiometabolic diseases is unknown. The objective of this secondary analysis is to investigate cardiometabolic risk factors changes after a 6-month weight-loss intervention in overweight/obese postmenopausal women divided in three groups: Ca+vitamin D supplements (S); low-fat dairy foods (D; 4−5 servings/day); or control/placebo pills (C), as complements to hypocaloric diets. The original study focused on bone/body composition. This analysis included blood pressure (BP), and serum triglycerides, lipids (including apoproteins Apo1 and ApoB), adipokines, and C-reactive protein in n = 97 participants who finished with complete data points. Systolic BP decreased 5.1%, 4.8%, and 1.8% in S, D, and C groups, respectively (p < 0.05 for S and D vs. baseline and vs. C at 6 months). Reduction in triglycerides and ratio of total cholesterol (TC)/high-density lipoproteins cholesterol (HDL-C) was the highest in S, while the reduction in TC and LDL-C was the highest in D group (all p < 0.05). Leptin and ApoB significantly decreased and adiponectin and ApoA1 increased in all groups. In conclusion, although the C group’s participants experienced an improvement in some of the cardiometabolic indices with weight loss, those in the S and D groups showed significantly better results in most of the outcomes, indicating the beneficial effects of low-fat dairy foods and/or Ca+vitamin D intake as complements to a hypocaloric diet.
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Affiliation(s)
- Jasminka Z. Ilich
- Institute for Successful Longevity, Florida State University, Tallahassee, FL 32306, USA
- Correspondence: ; Tel.: +1-850-691-8770
| | - Pei-Yang Liu
- School of Exercise and Nutrition Sciences, University of Akron, Akron, OH 44325, USA;
| | - Hyehyung Shin
- Department of Social Welfare, Pusan National University, Pusan 46241, Korea;
| | - Youjin Kim
- GNC Holdings, LLC, Pittsburg, PA 15222, USA;
| | - Yichih Chi
- Independent Researcher, Fremont, CA 94539, USA;
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Abstract
Coexisting dysfunction of heart and kidney, the cardiorenal syndrome, is a common condition and is associated with worsening of outcomes and complexities of diagnostic, preventive, and therapeutic approaches. The knowledge of the physiology of heart and kidney and their interaction with each other and with other organ systems has progressed significantly in recent years, resulting in a better understanding of the pathogenesis of cardiorenal syndrome. A robust knowledge of the pathophysiology and of the latest practical advancements about cardiorenal syndrome is necessary for cardiologists, nephrologists, and other practitioners who provide medical care to the patients with heart and kidney diseases.
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Affiliation(s)
- Parta Hatamizadeh
- Department of Medicine, Division of Nephrology, Hypertension & Renal Transplantation, University of Florida, 1600 SW Archer Road, CG-98, PO Box 100224, Gainesville, FL 32610, USA.
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Xu H, Peng W, Yang Z, Zhang Y, Xia C, Li Z, Xu R, Guo Y. The association of secondary hyperparathyroidism and myocardial damages in hemodialysis end-stage renal disease patients: assessed by cardiovascular magnetic resonance native T1 mapping. J Cardiovasc Magn Reson 2021; 23:23. [PMID: 33691727 PMCID: PMC7949248 DOI: 10.1186/s12968-021-00713-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 01/26/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Secondary hyperparathyroidism is a common complication of end-stage renal disease (ESRD), which may be associated with cardiovascular diseases. Thus, this study aimed to explore myocardial damage using non-contrast cardiovascular magnetic resonance (CMR) in ESRD patients undergoing hemodialysis and further investigate its relationship with parathyroid hormone (PTH) toxicity. METHODS Seventy-two adult ESRD patients receiving regular hemodialysis and 30 healthy subjects underwent CMR examination. Continuous CMR cine sections from the mitral valve level to the left ventricular (LV) apex in the short-axis plane, cine series of vertical two-chamber long-axis plane, and horizontal four-chamber plane were acquired. Native T1 mapping was obtained using modified Look-Locker inversion recovery (MOLLI) sequences. Native T1 values and myocardial strain were analyzed. Immunoreactive parathyroid hormone (iPTH) was obtained from all enrolled patients. RESULTS Forty (55.6%) hemodialysis ESRD patients were found to have increased iPTH levels. LV ejection fraction (LVEF) of both ESRD patients with targeted and increased iPTH levels was decreased compared with healthy subjects (55.9 ± 12.0% vs. 65.0 ± 4.5%; 51.7 ± 12.8 vs. 65.0 ± 4.5%, both P < 0.05). The mean peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) were lowest in ESRD patients with increased iPTH; however, no significant difference was observed among these three groups. Segmentally, from base to apex, the native T1 of ESRD patients with increased iPTH levels tended to be higher than those with targeted iPTH and healthy subjects (all P < 0.05). In ESRD patients with targeted iPTH, both native T1 of basal and middle segments were significantly higher than normal subjects (basal, 1304 ± 41 ms vs. 1238 ± 36 ms, P = 0.001; middle, 1300 ± 43 ms vs. 1242 ± 50 ms, P < 0.001). Comparing global native T1 values in the three groups, ESRD patients with targeted and increased iPTH level showed increased native T1 (1305 ± 41 ms vs. 1251 ± 49 ms, P = 0.001; 1334 ± 40 ms vs. 1251 ± 49 ms, P < 0.001, respectively). Native T1 values of the basal segment and global native T1 were moderately associated with iPTH (r = 0.4, P < 0.001; r = 0.5, P < 0.001). Multiple linear regression analysis showed that global native T1 values (beta = 1.0, P = 0.01) were independently associated with iPTH. CONCLUSIONS Elevated iPTH level was associated with and was an independent risk factor for myocardial damage in ESRD patients undergoing maintenance hemodialysis. TRIAL REGISTRATION Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) ChiCTR-DND-17012976, 13/12/2017, retrospectively registered.
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Affiliation(s)
- Huayan Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Ren min Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Ren min Road, Chengdu, 610041, Sichuan, China
| | - Wanlin Peng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhigang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yi Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Rong Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Ren min Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Ren min Road, Chengdu, 610041, Sichuan, China
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Ren min Road, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Ren min Road, Chengdu, 610041, Sichuan, China.
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Loncar G, Cvetinovic N, Lainscak M, Isaković A, von Haehling S. Bone in heart failure. J Cachexia Sarcopenia Muscle 2020; 11:381-393. [PMID: 32087616 PMCID: PMC7113538 DOI: 10.1002/jcsm.12516] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in osteoporosis and reduced bone mineral density affecting not only post-menopausal women but also men, particularly with coexisting chronic diseases. Bone status in patients with stable chronic heart failure (HF) has been rarely studied so far. HF and osteoporosis are highly prevalent aging-related syndromes that exact a huge impact on society. Both disorders are common causes of loss of function and independence, and of prolonged hospitalizations, presenting a heavy burden on the health care system. The most devastating complication of osteoporosis is hip fracture, which is associated with high mortality risk and among those who survive, leads to a loss of function and independence often necessitating admission to long-term care. Current HF guidelines do not suggest screening methods or patient education in terms of osteoporosis or osteoporotic fracture. This review may serve as a solid base to discuss the need for bone health evaluation in HF patients.
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Affiliation(s)
- Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center 'Dr. Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
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7
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Kontogeorgos G, Welin L, Fu M, Hansson PO, Landin-Wilhelmsen K, Laine CM. Hyperparathyroidism in men - morbidity and mortality during 21 years' follow-up. Scand J Clin Lab Invest 2019; 80:6-13. [PMID: 31718337 DOI: 10.1080/00365513.2019.1683763] [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] [Indexed: 10/25/2022]
Abstract
Hyperparathyroidism (HPT), including normocalcaemic, vitamin D sufficient (Serum (S)-25(OH)D ≥ 50 nmol/L) hyperparathyroidism (nHPT), has increasingly been diagnosed in the last few decades due to the more common use of the serum parathyroid hormone (S-PTH) assay. We investigated if men with HPT had higher morbidity and mortality than men without HPT during 21 years' follow-up.A random population sample of 750 men, all 50 years of age, was examined in 1993. Endpoints were retrieved 21 years later at 71 years of age.Albumin-corrected serum (S) calcium, S-25-hydroxyvitamin D and S-PTH were assessed along with data on cardiovascular risk factors and medication. Outcome data on fractures, stroke, myocardial infarction, cancer and death were retrieved in 2014; 21 years after primary assessment. The prevalence of HPT at 50 years of age was 9.3%; nHPT 2.8%, primary HPT 0.4%, secondary HPT 0.4%, and HPT with vitamin D insufficiency 6%. Fracture rate, myocardial infarction, stroke, cancer and death occurred similarly in men with or without HPT, as well as in men with nHPT as compared with men without calcium/PTH aberrations during 21 years' follow-up. S-PTH was evenly distributed in the univariable analyses for each outcome. Cox regression analyses showed no increase in serious morbidity or in mortality in men with HPT, irrespective of cause, compared with men with normal S-PTH over a 21-year period. None had HPT at a S-25(OH)D level of 100 nmol/L.
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Affiliation(s)
- Georgios Kontogeorgos
- Section for Endocrinology, Department of Medicine, Sahlgrenska University Hospital, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Welin
- Department of Medicine, Lidköping Hospital, Lidköping, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Section for Endocrinology, Department of Medicine, Sahlgrenska University Hospital, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christine M Laine
- Section for Endocrinology, Department of Medicine, Sahlgrenska University Hospital, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Nilsson IL. Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties. J Intern Med 2019; 285:149-164. [PMID: 30289185 DOI: 10.1111/joim.12840] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and is characterized by hypercalcaemia and elevated or inappropriately 'normal' levels of the parathyroid hormone (PTH). The main target organs of PTH are the skeletal system and the kidneys. Before the 1970s, pHPT was a rarely detected disease associated with notable morbidity and premature mortality. Introduction of biochemical screening, allowing for a wide range of indications, has contributed to the detection of the full spectrum of the disease. A new entity with an isolated elevation of PTH, normocalcaemic HP, has emerged and is currently being explored. The highest incidence of pHPT, 3-5%, is observed amongst women, and the prevalence increases with age. The female-to-male ratio is 3-4 : 1 except in younger patients where distribution is equal and known hereditary causes account for approximately 10% of the cases. In the last few decades, it has become evident that fewer patients than previously believed are truly asymptomatic. The cause of pHPT is often a benign tumour, a parathyroid adenoma, and the only definite treatment is parathyroidectomy (PTX). No medical treatment, single or combined, can achieve a curing of pHPT. Recent data indicate that PTX, despite being proven to be cost-effective compared to conservative treatment, is underutilized, especially in elderly pHPT patients. The decision of PTX should always be based on a safe diagnosis, and the potential benefits of curative treatment should not be outweighed by the risks of surgery or anaesthesia.
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Affiliation(s)
- I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department ofBreast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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Parathyroid Hormone Causes Endothelial Dysfunction by Inducing Mitochondrial ROS and Specific Oxidative Signal Transduction Modifications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:9582319. [PMID: 30662585 PMCID: PMC6313989 DOI: 10.1155/2018/9582319] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/04/2018] [Indexed: 01/10/2023]
Abstract
Vitamin D deficiency contributes to cardiovascular risk (CVR), with hyperparathyroidism advocated as a putative mechanism. Indeed, mounting evidence supports the hypothesis that parathyroid hormone (PTH) impairs endothelial function, even though mechanisms are not fully elucidated. The present study was designed to verify in vitro the ability of sustained exposure to PTH to cause endothelial dysfunction, exploring the underlying mechanisms. In bovine aortic endothelial cells (BAECs), we evaluated the effects of PTH exposure (0.1 nM–24 hours) on both endothelial response to vasodilators, such as bradykinin (Bk (30 nM)) and acetylcholine (Ach (1 μM)), and angiogenic competence. Pretreatment with PTH impaired endothelial response to Bk but not to Ach, in terms of cytosolic calcium fluxes and NO production. In order to explore the underlying mechanisms, we assessed the production of total and mitochondrial ROS (tROS and mROS, respectively) in response to PTH (at 1 and 3 hours). PTH increased ROS generation, to an extent high enough to determine oxidation of Bk receptor B2. Conversely, the oxidation levels of M1 and M3 Ach receptors were not affected by PTH. A mROS selective scavenger (MitoTEMPO (5 μM)) restored the endothelial responsiveness to Bk while the well-known antioxidant properties of vitamin D (100 nM) failed to counteract PTH-mediated oxidative stress. PTH determined mitochondrial calcium fluxes ([Ca2+]mt) and the mitochondrial calcium uniporter inhibitor Ru360 (10 μM) reduced mROS production and prevented the PTH-mediated endothelial dysfunction. Angiogenic competence was evaluated as tubular formations in the endothelial Matrigel assay and showed a significant impairment in PTH-pretreated cells (0.1 nM–24 hours), despite the increase in VEGF transcriptional levels. VEGFR2 oxidation occurred in response to PTH, suggesting that even the impairment of angiogenesis was due to the ROS surge. These results indicate that PTH affects endothelial function through ROS production, driven by mitochondrial calcium overload. PTH-induced oxidative stress might act as signaling modifiers, altering specific pathways (Bk and VEGF) and preserving others (Ach).
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10
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Rangaswami J, McCullough PA. Heart Failure in End-Stage Kidney Disease: Pathophysiology, Diagnosis, and Therapeutic Strategies. Semin Nephrol 2018; 38:600-617. [DOI: 10.1016/j.semnephrol.2018.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure. Eur J Nutr 2018; 58:2535-2543. [PMID: 30121806 PMCID: PMC6689317 DOI: 10.1007/s00394-018-1806-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/02/2018] [Indexed: 01/14/2023]
Abstract
Purpose Low 25-hydroxyvitamin D (25[OH]D) concentrations have been associated with adverse outcomes in selected populations with established chronic heart failure (CHF). However, it remains unclear whether 25[OH]D deficiency is associated with mortality and hospitalisation in unselected patients receiving contemporary medical and device therapy for CHF. Methods We prospectively examined the prevalence and correlates of 25[OH]D deficiency in 1802 ambulatory patients with CHF due to left ventricular systolic dysfunction (left ventricular ejection fraction ≤ 45%) attending heart failure clinics in the north of England. Results 73% of patients were deficient in 25[OH]D (< 50 nmol/L). 25[OH]D deficiency was associated with male sex, diabetes, lower serum sodium, higher heart rate, and greater diuretic requirement. During a mean follow-up period of 4 years, each 2.72-fold increment in 25[OH]D concentration (for example from 32 to 87 nmol/L) is associated with 14% lower all-cause mortality (95% confidence interval (CI) 1, 26%; p = 0.04), after accounting for potential confounding factors. Conclusions Low 25-hydroxyvitamin D deficiency is associated with increased mortality in patients with chronic heart failure due to left ventricular systolic dysfunction. Whether vitamin D supplementation will improve outcomes is, as yet, unproven. Electronic supplementary material The online version of this article (10.1007/s00394-018-1806-y) contains supplementary material, which is available to authorized users.
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Concistrè A, Grillo A, La Torre G, Carretta R, Fabris B, Petramala L, Marinelli C, Rebellato A, Fallo F, Letizia C. Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism. Endocrine 2018; 60:129-137. [PMID: 28702887 DOI: 10.1007/s12020-017-1362-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. PURPOSE The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. METHODS Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. RESULTS Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire primary hyperparathyroidism patients group (P = 0.04, P = 0.02; respectively). CONCLUSION Systolic blood pressure variability is increased in normotensive patients with primary hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.
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Affiliation(s)
- A Concistrè
- Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy
| | - A Grillo
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - G La Torre
- Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy
| | - R Carretta
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - B Fabris
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - L Petramala
- Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy
| | - C Marinelli
- Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy
| | - A Rebellato
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - F Fallo
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - C Letizia
- Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy.
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The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases. DISEASE MARKERS 2018; 2018:5287573. [PMID: 29599854 PMCID: PMC5831602 DOI: 10.1155/2018/5287573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Abstract
25-hydroxyvitamin D (25(OH)D) plays a crucial role in human homeostasis. Its deficiency (vitamin D deficiency—VDD), being common in European population, combined with elevated concentration of parathyroid hormone (PTH), represents a vicious cycle of mechanisms leading to heart failure (HF). Despite several papers published in that field, the effect of VDD and PTH concentration on cardiovascular system remains unequivocal; thus, the aim of the study was to compare these data among HF and non-HF patients being prospectively enrolled into the study during hospital stay in the cardiology ward. Patients with HF had higher PTH concentration (85.0 ± 52.6 versus 64.5 ± 31.7, p ≤ 0.02) compared to non-HF patients. Mean PTH values were associated with the clinical status expressed by the New York Heart Association class (NYHA class) (“0”—66.04, “I”—56.57, “II”—72.30, “III”—85.59, and “IV”—144.37 pg/ml, p ≤ 0.00004). Interestingly, neither 25(OH)D (31.5 versus 29.7 ng/ml, p ≤ ns) nor phosphorus (P) (1.23 versus 1.18 mmol/l, p ≤ ns) nor total calcium (Ca2+) concentration (2.33 versus 2.37 mmol/l, p ≤ ns) differed among the groups. Reassuming PTH serum concentration in contrary to 25(OH)D, P and Ca2+ are significantly raised among the patients with HF and shows significant relationship with the clinical status expressed by the NYHA class.
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Palmeri NO, Davidson KW, Whang W, Kronish IM, Edmondson D, Walker MD. Parathyroid hormone is related to QT interval independent of serum calcium in patients with coronary artery disease. Ann Noninvasive Electrocardiol 2017; 23:e12496. [PMID: 28949082 DOI: 10.1111/anec.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Elevated serum parathyroid hormone (PTH) is associated with increased risk of cardiovascular death, including sudden cardiac death, in patients with and without parathyroid disease. In small studies, PTH levels have been associated with changes in cardiac conduction and repolarization. Changes in the corrected QT interval (QTc) in particular are thought to be mediated by the effect of PTH on serum calcium. There is limited evidence to suggest PTH may affect cardiac physiology independent of its effects on serum calcium, but there is even less data linking PTH to changes in electrical conduction and repolarization independent of serum calcium. METHODS ECG data were examined from the PULSE database-an observational cohort study designed to examine depression after acute coronary syndromes (ACS) at a single, urban American medical center. In all, 407 patients had PTH and ECG data for analysis. RESULTS The QTc was longer in patients with elevated PTH levels compared with those without elevated PTH levels (451 ± 38.6 ms vs. 435 ± 29.8 ms; p < .001). The difference remained statistically significant after controlling for calcium, vitamin D, and estimated glomerular filtration rate (p = .007). Inclusion of left ventricular ejection fraction in the model attenuated the association (p = .054), suggesting that this finding may be partly driven by changes in cardiac structure. CONCLUSIONS In one of the largest series to examine PTH, calcium, and QT changes, we found that elevated PTH is associated with longer corrected QT interval independent of serum calcium concentration in ACS survivors.
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Affiliation(s)
| | | | | | - Ian M Kronish
- Columbia University Medical Center, New York, NY, USA
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15
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Khezri BS, Cederblad M, Helmersson-Karlqvist J, Karlsson B, Melhus H, Larsson A. Seasonal variability of NT-proBNP in Swedish primary care patients. Chronobiol Int 2017; 34:1473-1477. [PMID: 28910541 DOI: 10.1080/07420528.2017.1366500] [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: 10/18/2022]
Abstract
The aim of this study was to determine if there is a seasonal variation in the widely used heart failure marker NT-proBNP. The study included all primary care requests for NT-proBNP in the county of Uppsala, Sweden, between January 2007 and December 2015. For seasonal variation, the NT-proBNP results for individual months were compared. The NT-proBNP values were highest in July to September, but there was also a minor peak in December-January. In conclusion, a seasonal periodicity for NT-proBNP was demonstrated in primary care patients. The data could be useful for practitioners for evaluation of NT-proBNP results and monitoring of patients with heart failure.
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Affiliation(s)
- Banafsheh Seyyed Khezri
- a Department of Medical Sciences , Uppsala University Hospital, Uppsala University , Uppsala , Sweden
| | - Maria Cederblad
- b Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
| | | | - Bo Karlsson
- b Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
| | - Håkan Melhus
- a Department of Medical Sciences , Uppsala University Hospital, Uppsala University , Uppsala , Sweden
| | - Anders Larsson
- a Department of Medical Sciences , Uppsala University Hospital, Uppsala University , Uppsala , Sweden
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16
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Verheyen N, Fahrleitner-Pammer A, Belyavskiy E, Gruebler MR, Dimai HP, Amrein K, Ablasser K, Martensen J, Catena C, Pieske-Kraigher E, Colantonio C, Voelkl J, Lang F, Alesutan I, Meinitzer A, März W, Brussee H, Pieske B, Pilz S, Tomaschitz A. Relationship between bone turnover and left ventricular function in primary hyperparathyroidism: The EPATH trial. PLoS One 2017; 12:e0173799. [PMID: 28406904 PMCID: PMC5390970 DOI: 10.1371/journal.pone.0173799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 02/26/2017] [Indexed: 02/07/2023] Open
Abstract
Observational studies suggested a link between bone disease and left ventricular (LV) dysfunction that may be pronounced in hyperparathyroid conditions. We therefore aimed to test the hypothesis that circulating markers of bone turnover correlate with LV function in a cohort of patients with primary hyperparathyroidism (pHPT). Cross-sectional data of 155 subjects with pHPT were analyzed who participated in the "Eplerenone in Primary Hyperparathyroidism" (EPATH) Trial. Multivariate linear regression analyses with LV ejection fraction (LVEF, systolic function) or peak early transmitral filling velocity (e', diastolic function) as dependent variables and N-terminal propeptide of procollagen type 1 (P1NP), osteocalcin (OC), bone-specific alkaline phosphatase (BALP), or beta-crosslaps (CTX) as the respective independent variable were performed. Analyses were additionally adjusted for plasma parathyroid hormone, plasma calcium, age, sex, HbA1c, body mass index, mean 24-hours systolic blood pressure, smoking status, estimated glomerular filtration rate, antihypertensive treatment, osteoporosis treatment, 25-hydroxy vitamin D and N-terminal pro-brain B-type natriuretic peptide. Independent relationships were observed between P1NP and LVEF (adjusted β-coefficient = 0.201, P = 0.035) and e' (β = 0.188, P = 0.042), respectively. OC (β = 0.192, P = 0.039) and BALP (β = 0.198, P = 0.030) were each independently related with e'. CTX showed no correlations with LVEF or e'. In conclusion, high bone formation markers were independently and paradoxically related with better LV diastolic and, partly, better systolic function, in the setting of pHPT. Potentially cardio-protective properties of stimulated bone formation in the context of hyperparathyroidism should be explored in future studies.
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Affiliation(s)
- Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Evgeny Belyavskiy
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Martin R. Gruebler
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Hans Peter Dimai
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Klemens Ablasser
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Johann Martensen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Elisabeth Pieske-Kraigher
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Jakob Voelkl
- Department of Physiology, University of Tübingen, Tübingen, Germany
| | - Florian Lang
- Department of Physiology, University of Tübingen, Tübingen, Germany
| | - Ioana Alesutan
- Department of Physiology, University of Tübingen, Tübingen, Germany
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, 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
| | - Helmut Brussee
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Burkert Pieske
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
- Department of Health Sciences and the EMGO Institute, VU University Amsterdam, 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
- Specialist Clinic for Rehabilitation Bad Gleichenberg, Bad Gleichenberg, Austria
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17
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Fohtung RB, Brown DL, Koh WJH, Bartz TM, Carbone LD, Civitelli R, Stein PK, Chaves PHM, Kestenbaum BR, Kizer JR. Bone Mineral Density and Risk of Heart Failure in Older Adults: The Cardiovascular Health Study. J Am Heart Assoc 2017; 6:e004344. [PMID: 28288973 PMCID: PMC5523996 DOI: 10.1161/jaha.116.004344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/17/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (BMD) and heart failure (HF) risk remains insufficiently studied. METHODS AND RESULTS We investigated whether BMD measured by dual-energy x-ray absorptiometry was associated with incident HF in an older cohort. Cox models were stratified by sex and interactions of BMD with race assessed. BMD was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55% women) developed HF during the median follow-up of 10.5 years. In both black and nonblack women, neither total hip nor femoral neck BMD was significantly associated with HF; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck, BMD was significantly associated with HF, with evidence of an interaction by race. In nonblack men, lower total hip BMD was associated with higher HF risk (hazard ratio, 1.13 [95% CI, 1.01-1.26] per 0.1 g/cm2 decrement), whereas in black men, lower total hip BMD was associated with lower HF risk (hazard ratio, 0.74 [95% CI, 0.59-0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher HF risk (hazard ratio, 2.83 [95% CI, 1.39-5.74]) compared with normal BMD. CONCLUSIONS Among older adults, lower total hip BMD was associated with higher HF risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.
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Affiliation(s)
- Raymond B Fohtung
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - David L Brown
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - William J H Koh
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Laura D Carbone
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA
- Charlie Norwood Veterans Affairs, Augusta, GA
| | - Roberto Civitelli
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Phyllis K Stein
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Department of Medicine, Family Medicine, and Community Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Bryan R Kestenbaum
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jorge R Kizer
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Meijers WC, van der Velde AR, Muller Kobold AC, Dijck-Brouwer J, Wu AH, Jaffe A, de Boer RA. Variability of biomarkers in patients with chronic heart failure and healthy controls. Eur J Heart Fail 2016; 19:357-365. [PMID: 27766733 PMCID: PMC5347881 DOI: 10.1002/ejhf.669] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 12/27/2022] Open
Abstract
Aims Biomarkers can be used for diagnosis, risk stratification, or management of patients with heart failure (HF). Knowledge about the biological variation is needed for proper interpretation of serial measurements. Therefore, we aimed to determine and compare the biological variation of a large panel of biomarkers in healthy subjects and in patients with chronic HF. Methods and results The biological variability of established biomarkers [NT‐proBNP and high‐sensitivity troponin T (hsTnT)], novel biomarkers [galectin‐3, suppression of tumorigenicity 2 (ST2), and growth differentiation factor 15 (GDF‐15)], and renal/neurohormonal biomarkers (aldosterone, phosphate, parathyroid hormone, plasma renin concentration, and creatinine) was determined in 28 healthy subjects and 83 HF patients, over a period of 4 months and 6 weeks, respectively. The analytical (CVa), intraindividual (CVi), and interindividual (CVg) variations were calculated, as well as the reference change value (RCV), which reflects the percentage of change that may indicate a ‘relevant’ change. All crude biomarker levels were significantly increased or decreased in HF patients compared with controls (all P < 0.01). Variation indices were comparable in healthy individuals and HF patients. CVi was not influenced by the individual levels of the biomarker itself. NT‐proBNP and GDF‐15 had relatively high CVi (21.8% and 16.6%) and RCV (61.7% and 64.3%), whereas ST2 (CVi, 15.0; RCV, 42.9%), hsTnT (CVi, 11.1; RCV, 31.4%), and galectin‐3 (CVi, 8.1; RCV, 25.0%) had lower indices of variation. Conclusion Biological variation indices are comparable between healthy subjects and HF patients for a broad spectrum of biomarkers. NT‐proBNP and GDF‐15 have substantial variation, with lower variation for ST2, hsTnT, and galectin‐3. These data are instrumental in proper interpretation of biomarker levels in HF patients.
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Affiliation(s)
- Wouter C Meijers
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Rogier van der Velde
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janneke Dijck-Brouwer
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alan H Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Allan Jaffe
- Departments of Cardiovascular Diseases and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Meng F, Wang W, Ma J, Lin B. Parathyroid hormone and risk of heart failure in the general population: A meta-analysis of prospective studies. Medicine (Baltimore) 2016; 95:e4810. [PMID: 27749533 PMCID: PMC5059035 DOI: 10.1097/md.0000000000004810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Inconsistent findings have been reported on the association between the parathyroid hormone (PTH) level and risk of heart failure. We aimed to systematically evaluate the association between circulating level of PTH and risk of heart failure in the general population by conducting a meta-analysis. We made a comprehensive literature search in PubMed, Embase, VIP, CNKI, and Wanfang databases published until January 2016. Only prospective observational studies reporting the association between circulating level of PTH and risk of heart failure in the general population were selected. Pooled adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) were calculated for the highest versus lowest PTH category. Six studies with 25,207 participants identified. Higher circulating level of PTH was associated with an increased risk of heart failure (HR: 1.38; 95% CI 1.09-1.74) in a random effect model. Subgroup analyses revealed that the risk of heart failure was more pronounced among men (HR: 1.75; 95% CI 1.38-2.22) than in both genders. However, the risk increment was not statistically significant (HR: 1.12; 95% CI 0.76-1.66) in the middle-aged population. Higher PTH level is independently associated with an exacerbated risk of heart failure in the general population.
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Affiliation(s)
| | - Wei Wang
- Department of Cardiac Surgery, China-Japan Union hospital of Jilin University, Changchun, China
| | - Jianghong Ma
- Department of Cardiac Surgery, China-Japan Union hospital of Jilin University, Changchun, China
| | - Baisong Lin
- Department of Cardiac Surgery, China-Japan Union hospital of Jilin University, Changchun, China
- Correspondence: Prof. Baisong Lin, Department of Cardiology, China-Japan Union hospital of Jilin University, No. 126 Xiantai Street, Changchun 130033, China (e-mail: )
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20
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Yang B, Lu C, Wu Q, Zhang J, Zhao H, Cao Y. Parathyroid hormone, cardiovascular and all-cause mortality: A meta-analysis. Clin Chim Acta 2016; 455:154-60. [PMID: 26835752 DOI: 10.1016/j.cca.2016.01.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Inconsistent findings have reported on parathyroid hormone (PTH) concentration and cardiovascular or all-cause mortality. OBJECTIVE To investigate whether elevated PTH concentration was an independent predictor for cardiovascular or all-cause mortality in the general population by conducting a meta-analysis based on prospective studies. METHOD We searched Cochrane Library, Pubmed, and Embase databases up to June 2015. Only prospective studies evaluating serum PTH concentration and cardiovascular or all-cause mortality were included. Pooled adjust risk ratio (RR) and corresponding 95% confidence intervals (CI) were calculated for the highest vs. lowest PTH concentration. RESULTS Ten studies with 31,616 subjects were identified and analyzed. Compared the highest to the lowest PTH concentration, elevated serum PTH concentration increased the risk of all-cause mortality (RR 1.19; 95% CI 1.08-1.30) but not for cardiovascular mortality (RR 1.26; 95% CI 0.96-1.66). Subgroup analyses indicated that cardiovascular mortality risk appeared to be more pronounced among men (RR 1.68; 95% CI 1.05-2.67). CONCLUSIONS Elevated PTH concentration is an independent predictor of all-cause mortality. Elevated serum PTH concentration appears to increase risk of cardiovascular mortality among men.
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Affiliation(s)
- Bo Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
| | - Changlin Lu
- Department of Cardiology, Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing 100020, China.
| | - Qing Wu
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jian Zhang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hua Zhao
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yukang Cao
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
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Wahab IA, Pratt NL, Ellett LK, Roughead EE. Sequence Symmetry Analysis as a Signal Detection Tool for Potential Heart Failure Adverse Events in an Administrative Claims Database. Drug Saf 2016; 39:347-54. [DOI: 10.1007/s40264-015-0391-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Aceña Á, Pello AM, Carda R, Lorenzo Ó, Gonzalez-Casaus ML, Blanco-Colio LM, Martín-Ventura JL, Palfy J, Orejas M, Rábago R, Gonzalez-Parra E, Mahíllo-Fernández I, Farré J, Egido J, Tuñón J. Parathormone Levels Are Independently Associated with the Presence of Left Ventricular Hypertrophy in Patients with Coronary Artery Disease. J Nutr Health Aging 2016; 20:659-64. [PMID: 27273357 DOI: 10.1007/s12603-015-0649-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abnormalities of mineral metabolism and inflammation may affect the cardiovascular system. We have assessed the relationship of left ventricular hypertrophy (LVH) with inflammation and mineral metabolism. METHODS LVH was measured in 146 outpatients with stable coronary artery disease (SCAD) using echocardiography. Calcidiol (a vitamin D metabolite), parathyroid hormone (PTH), fibroblast growth factor-23, high-sensitivity C-reactive protein, MCP-1 (monocyte chemoattractant protein-1), galectin-3, NGAL (neutrophil gelatinase-associated lipocalin), and sTWEAK (soluble TNF-related weak inducer of apoptosis) plasma levels were studied. RESULTS LVH, defined as septal thickness ≥11 mm, was present in 19.9% of cases. These patients were older [75.0 (61.0-81.0) vs 64.0 (51.0-76.0) years; p=0.002], had higher prevalence of left ventricular ejection fraction (LVEF)>40%, and had higher PTH [84.7 (59.6-104.7) vs 63.2 (49.2-85.2) pg/ml; p=0.007], galectin-3 [9.6 (8.0-11.1) vs 8.3 (6.9-9.9) ng/ml; p=0.037], and NGAL (208.5±87.6 vs 173.9±73.4 ng/ml; p=0.031) plasma levels than those without LVH. Glomerular filtration rate was lower in patients with LVH than in those without it (65.1±20.0 vs 74.7±19.9 mL/min/1.73 m2; p=0.021). There were no significant differences in hypertension (79.3 vs 68.4%; p=0.363) or sex between both groups. Variables showing differences based on univariate analysis and hypertension were entered into a logistic regression analysis. Only age [odds ratio (OR) =1.052 (1.011-1.096); p=0.013], PTH plasma levels [OR=1.017 (1.003-1.031); p=0.021], and LVEF>40% [OR=7.595 (1.463-39.429); p=0.016] were independent predictors of LVH. CONCLUSIONS In patients with SCAD, elevated PTH levels are independently associated with the presence of LVH. Further studies are needed to elucidate the role of PTH in the development of myocardial hypertrophy.
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Affiliation(s)
- Á Aceña
- José Tuñón, Department of Cardiology, IIS-Fundación Jiménez Díaz-UAM, Avenida Reyes Católicos 2, 28040 Madrid, Spain, , Phone: 00-34-915504800 Ext-3701, Fax 00-34-915504904
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Verheyen ND, Kienreich K, Gaksch M, van Ballegooijen AJ, Grübler MR, Hartaigh BÓ, Schmid J, Fahrleitner-Pammer A, Kraigher-Krainer E, Colantonio C, Belyavskiy E, Treiber G, Catena C, Brussee H, Pieske B, März W, Tomaschitz A, Pilz S. Plasma Parathyroid Hormone Is Independently Related to Nocturnal Blood Pressure in Hypertensive Patients: The Styrian Hypertension Study. J Clin Hypertens (Greenwich) 2015; 18:543-50. [DOI: 10.1111/jch.12710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/12/2015] [Accepted: 08/16/2015] [Indexed: 12/21/2022]
Affiliation(s)
| | - Katharina Kienreich
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Martin Gaksch
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | | | - Martin R. Grübler
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Briain Ó. Hartaigh
- Department of Radiology; Dalio Institute of Cardiovascular Imaging; NewYork-Presbyterian Hospital and the Weill Cornell Medical College; New York NY
- Department of Internal Medicine; Section of Geriatrics; Yale School of Medicine; Adler Geriatric Center; New Haven CT
| | - Johannes Schmid
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Elisabeth Kraigher-Krainer
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | | | - Evgeny Belyavskiy
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - Gerlies Treiber
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Cristiana Catena
- Clinical Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Graz; Graz Austria
| | - Helmut Brussee
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - Burkert Pieske
- Department of Cardiology; Medical University of Graz; Graz Austria
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - Winfried März
- Hypertension Unit; Internal Medicine; Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
- Synlab Academy; Synlab Services LLC; Mannheim Germany
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology); Medical Faculty Mannheim; Ruperto Carola University Heidelberg; Mannheim Germany
| | - Andreas Tomaschitz
- Department of Cardiology; Medical University of Graz; Graz Austria
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
- Specialist Clinic for Rehabilitation; PV Bad Aussee; Bad Aussee Austria
| | - 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 Centre; Amsterdam the Netherlands
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Sood S, Gallagher IJ, Lunnon K, Rullman E, Keohane A, Crossland H, Phillips BE, Cederholm T, Jensen T, van Loon LJC, Lannfelt L, Kraus WE, Atherton PJ, Howard R, Gustafsson T, Hodges A, Timmons JA. A novel multi-tissue RNA diagnostic of healthy ageing relates to cognitive health status. Genome Biol 2015; 16:185. [PMID: 26343147 PMCID: PMC4561473 DOI: 10.1186/s13059-015-0750-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diagnostics of the human ageing process may help predict future healthcare needs or guide preventative measures for tackling diseases of older age. We take a transcriptomics approach to build the first reproducible multi-tissue RNA expression signature by gene-chip profiling tissue from sedentary normal subjects who reached 65 years of age in good health. RESULTS One hundred and fifty probe-sets form an accurate classifier of young versus older muscle tissue and this healthy ageing RNA classifier performed consistently in independent cohorts of human muscle, skin and brain tissue (n = 594, AUC = 0.83-0.96) and thus represents a biomarker for biological age. Using the Uppsala Longitudinal Study of Adult Men birth-cohort (n = 108) we demonstrate that the RNA classifier is insensitive to confounding lifestyle biomarkers, while greater gene score at age 70 years is independently associated with better renal function at age 82 years and longevity. The gene score is 'up-regulated' in healthy human hippocampus with age, and when applied to blood RNA profiles from two large independent age-matched dementia case-control data sets (n = 717) the healthy controls have significantly greater gene scores than those with cognitive impairment. Alone, or when combined with our previously described prototype Alzheimer disease (AD) RNA 'disease signature', the healthy ageing RNA classifier is diagnostic for AD. CONCLUSIONS We identify a novel and statistically robust multi-tissue RNA signature of human healthy ageing that can act as a diagnostic of future health, using only a peripheral blood sample. This RNA signature has great potential to assist research aimed at finding treatments for and/or management of AD and other ageing-related conditions.
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Affiliation(s)
- Sanjana Sood
- XRGenomics Ltd, London, UK
- Division of Genetics & Molecular Medicine, King's College London, 8th Floor, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Iain J Gallagher
- XRGenomics Ltd, London, UK
- School of Health, Stirling University, Stirling, Scotland, UK
| | - Katie Lunnon
- Department of Old Age Psychiatry, King's College London, London, UK
- Present address: University of Exeter Medical School, Exeter, UK
| | - Eric Rullman
- Division of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Aoife Keohane
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Hannah Crossland
- Division of Genetics & Molecular Medicine, King's College London, 8th Floor, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
- School of Medicine, Derby Royal Hospital, Derbyshire, UK
| | | | - Tommy Cederholm
- Department of Public Health, Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | | | | | - Lars Lannfelt
- Department of Public Health and Caring Sciences/Molecular Geriatrics, Uppsala University, Uppsala, Sweden
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Robert Howard
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Thomas Gustafsson
- Division of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Angela Hodges
- Department of Old Age Psychiatry, King's College London, London, UK
| | - James A Timmons
- XRGenomics Ltd, London, UK.
- Division of Genetics & Molecular Medicine, King's College London, 8th Floor, Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
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Warriner D, Sheridan P, Lawford P. Heart failure: not a single organ disease but a multisystem syndrome. Br J Hosp Med (Lond) 2015; 76:330-6. [PMID: 26053903 DOI: 10.12968/hmed.2015.76.6.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Heart failure is not simply a single organ disease; rather it is a complex multi-system clinical syndrome, with impairment of endocrine, haematological, musculoskeletal, renal, respiratory and vascular systems, which influence morbidity and mortality.
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Affiliation(s)
- David Warriner
- Specialist Registrar in Cardiology in the Department of Cardiology Doncaster Royal Infimary, Doncaster DN2 5LT
| | - Paul Sheridan
- Consultant Electrophysiologist, Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Patricia Lawford
- Professor of Physiological Modelling in the Medical Physics Group, Department of Cardiovascular Science, The Medical School, University of Sheffield, Sheffield
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Kontogeorgos G, Trimpou P, Laine CM, Oleröd G, Lindahl A, Landin‐Wilhelmsen K. Normocalcaemic, vitamin D-sufficient hyperparathyroidism - high prevalence and low morbidity in the general population: A long-term follow-up study, the WHO MONICA project, Gothenburg, Sweden. Clin Endocrinol (Oxf) 2015; 83:277-84. [PMID: 25988687 PMCID: PMC4744766 DOI: 10.1111/cen.12819] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/04/2015] [Accepted: 05/10/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is limited knowledge about the natural history of normocalcaemic, vitamin D-sufficient hyperparathyroidism (nHPT). The aim was to study the prevalence of nHPT and its relation to morbidity. DESIGN Cross-sectional and retrospective study at the Sahlgrenska University Hospital, Gothenburg, Sweden. SUBJECTS A random population of 608 men and women, age 25-64 years, was studied in 1995 as part of the WHO MONICA study and reinvestigated in 2008 (n = 410, of whom 277 were vitamin D sufficient). MEASUREMENTS A serum intact parathyroid hormone (S-PTH) ≥60 ng/l was considered as HPT, S-calcium 2·15-2·49 mmol/l as normocalcaemia and S-25(OH)D ≥ 50 nmol/l as vitamin D sufficiency. Data on fractures, stroke and myocardial infarction were retrieved until 2013, that is a 17-year follow-up. RESULTS The prevalence of nHPT was 2·0% in 1995 (age 25-64) and 11·0% in 2008 (age 38-79). S-PTH was positively correlated with age and BMI. After adjustment for these variables, a high S-PTH level (≥60 ng/l) at follow-up was associated with previously low S-25(OH)D, high osteocalcin, S-PTH and both past and presently treated hypertension. No relation was seen with creatinine, cystatin C, malabsorption markers, thyroid function, glucose, insulin, lipids, calcaneal quantitative ultrasound, fractures, myocardial infarction, stroke or death at follow-up. CONCLUSIONS This small random population study showed that nHPT was common, 11% at follow-up. Only one individual developed mild hypercalcaemia in 13 years. Previous S-PTH was predictive of nHPT and hypertension was prevalent, but no increase in hard end-points was seen over a 17-year period.
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Affiliation(s)
- Georgios Kontogeorgos
- Section for EndocrinologyDepartment of MedicineSahlgrenska University Hospital at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Penelope Trimpou
- Section for EndocrinologyDepartment of MedicineSahlgrenska University Hospital at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Christine M. Laine
- Section for EndocrinologyDepartment of MedicineSahlgrenska University Hospital at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Göran Oleröd
- Department of Clinical ChemistrySahlgrenska University Hospital at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anders Lindahl
- Department of Clinical ChemistrySahlgrenska University Hospital at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kerstin Landin‐Wilhelmsen
- Section for EndocrinologyDepartment of MedicineSahlgrenska University Hospital at Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Abstract
Neurohormonal activation with attendant aldosteronism contributes to the clinical appearance of congestive heart failure (CHF). Aldosteronism is intrinsically coupled to Zn and Ca dyshomeostasis, in which consequent hypozincemia compromises Zn homeostasis and Zn-based antioxidant defenses that contribute to the CHF prooxidant phenotype. Ionized hypocalcemia leads to secondary hyperparathyroidism with parathyroid hormone-mediated Ca overloading of diverse cells, including cardiomyocytes. When mitochondrial Ca overload exceeds a threshold, myocyte necrosis follows. The reciprocal regulation involving cytosolic free [Zn]i as antioxidant and [Ca]i as prooxidant can be uncoupled in favor of Zn-based antioxidant defenses. Increased [Zn]i acts as a multifaceted antioxidant by: (1) inhibiting Ca entry through L-type channels and hence cardioprotectant from the Ca-driven mitochondriocentric signal-transducer effector pathway to nonischemic necrosis, (2) serving as catalytic regulator of Cu/Zn-superoxide dismutase, and (3) activating its cytosolic sensor, metal-responsive transcription factor that regulates the expression of relevant antioxidant defense genes. Albeit present in subnanomolar range, increased cytosolic free [Zn]i enhances antioxidant capacity that confers cardioprotection. It can be achieved exogenously by ZnSO4 supplementation or endogenously using a β3-receptor agonist (eg, nebivolol) that enhances NO generation to release inactive cytosolic Zn bound to metallothionein. By recognizing the pathophysiologic relevance of Zn dyshomeostasis in the prooxidant CHF phenotype and by exploiting the pharmacophysiologic potential of [Zn]i as antioxidant, vulnerable cardiomyocytes under assault from neurohormonal activation can be protected and the myocardium spared from adverse structural remodeling.
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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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Bell G, Huang S, Martin KJ, Block GA. A randomized, double-blind, phase 2 study evaluating the safety and efficacy of AMG 416 for the treatment of secondary hyperparathyroidism in hemodialysis patients. Curr Med Res Opin 2015; 31:943-52. [PMID: 25786369 DOI: 10.1185/03007995.2015.1031731] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Secondary hyperparathyroidism (SHPT) is a frequent complication of chronic kidney disease. We evaluated AMG 416, a long-acting peptide agonist of the calcium-sensing receptor, to assess its safety, tolerability, and efficacy and to determine a safe and effective starting dose for subsequent phase 2 studies. The study was not designed to titrate AMG 416 dosing to achieve a specific PTH treatment goal. RESEARCH DESIGN AND METHODS This is a multicenter, double-blind, randomized, placebo-controlled, dose-escalation study designed to evaluate the safety and efficacy of AMG 416 administered thrice weekly by IV bolus at the end of hemodialysis for up to 4 weeks. Eligible subjects were enrolled in one of three cohorts and treated with 5 mg of AMG 416 or placebo for 2 weeks (Cohort 1) or 5 or 10 mg of AMG 416 or placebo for 4 weeks (Cohorts 2 and 3). The primary endpoint was mean percentage change from baseline in PTH during the efficacy assessment phase (EAP) in Cohorts 2 and 3. RESULTS Analysis of the primary endpoint showed that treatment with AMG 416 at 10 mg (Cohort 2) and 5 mg (Cohort 3) for up to 4 weeks resulted in mean 49.4% and 33.0% reductions from baseline in PTH during the efficacy assessment phase, respectively (p < 0.05 for both cohorts compared to placebo group within the cohort). A substantial proportion of subjects treated with AMG 416 achieved PTH ≤300 pg/mL and ≥30% reduction in PTH from baseline in both cohorts. The observed decreases in serum-corrected calcium were well tolerated and serum phosphate levels also tended to decrease. CONCLUSIONS The present clinical findings support the continued development of AMG 416 as a treatment for SHPT in hemodialysis patients.
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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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Hagström E, Ahlström T, Ärnlöv J, Larsson A, Melhus H, Hellman P, Lind L. Parathyroid hormone and calcium are independently associated with subclinical vascular disease in a community-based cohort. Atherosclerosis 2015; 238:420-6. [DOI: 10.1016/j.atherosclerosis.2014.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/16/2014] [Accepted: 12/14/2014] [Indexed: 11/17/2022]
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Bansal N, Zelnick L, Robinson-Cohen C, Hoofnagle AN, Ix JH, Lima JA, Shoben AB, Peralta CA, Siscovick DS, Kestenbaum B, de Boer IH. Serum parathyroid hormone and 25-hydroxyvitamin D concentrations and risk of incident heart failure: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2014; 3:e001278. [PMID: 25468653 PMCID: PMC4338718 DOI: 10.1161/jaha.114.001278] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Heart failure (HF) is common and is associated with high mortality. We aimed to determine associations of serum parathyroid hormone (PTH) and 25‐hydroxyvitamin D (25[OH]D) with incident HF and left ventricular mass. Methods and Results Among 6459 participants in the community‐based Multi‐Ethnic Study of Atherosclerosis, all of whom were free of prevalent clinical cardiovascular disease, we measured serum concentrations of PTH and 25(OH)D at the baseline examination. In longitudinal analyses, we tested associations of PTH and 25(OH)D with incident HF events, adjudicated by a panel of physicians. In cross‐sectional analyses of a subset of 4763 participants, we tested associations of PTH and 25(OH)D with left ventricular mass, measured by cardiac magnetic resonance imaging at baseline. Multivariable Cox proportional hazard and linear regression models were adjusted for demographics, physical examination measures, comorbidity, kidney function, and other mineral metabolism markers. Mean age was 62 years and 53% of participants were female. There were 180 incident HF events over a median (interquartile range) follow‐up time of 8.46 (7.67 to 8.63) years. Compared with participants with PTH <65 pg/mL, PTH ≥65 pg/mL was associated with a 50% greater risk of incident HF (95% CI: 3% to 210%) and a 5.3 g higher left ventricular mass (95% CI: 2.6, 7.9 g). In contrast, there was no association of 25(OH)D with risk of incident HF or elevated left ventricular mass. Conclusions In a racially/ethnically diverse population without prevalent cardiovascular disease, higher serum PTH concentration was associated with increased left ventricular mass and increased risk of incident HF. Further studies should be pursued to determine whether PTH excess may be a modifiable risk factor for HF.
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Affiliation(s)
- Nisha Bansal
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Leila Zelnick
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Cassianne Robinson-Cohen
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Andy N Hoofnagle
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Joachim H Ix
- University of California, San Diego, CA (J.H.I.)
| | - Joao A Lima
- Johns Hopkins University, Baltimore, MD (J.A.L.)
| | | | | | | | - Bryan Kestenbaum
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
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Poelzl G, Trenkler C, Kliebhan J, Wuertinger P, Seger C, Kaser S, Mayer G, Pirklbauer M, Ulmer H, Griesmacher A. FGF23 is associated with disease severity and prognosis in chronic heart failure. Eur J Clin Invest 2014; 44:1150-8. [PMID: 25294008 DOI: 10.1111/eci.12349] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/03/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Elevated levels of fibroblast growth factor 23 (FGF23) are associated with incident heart failure in individuals with or without chronic kidney disease. We aimed to investigate the association between serum FGF23 concentrations and disease severity and long-term outcome in patients with stable heart failure. MATERIALS AND METHODS Serum levels of C-term FGF23 (Ct-FGF23) concentrations, inorganic phosphate (Pi ), parathormone (PTH) and 25-hydroxyvitamin D (25(OH)D) were measured in 208 patients with nonischaemic heart failure (age 48 ± 15 years; 70% male; NYHA Class I 27·8%, NYHA Class II 43·4%, NYHA Class III/IV 28·8%; LV-EF 34 ± 15%; eGFR ≥60 mL/min/1·73 m(2) in 86%). RESULTS Median Ct-FGF23 levels were 18·2 RU/mL (7·5-40·8RU/mL). A dose-response relationship was found between median Ct-FGF23 levels and increasing NYHA class (I: 11·9 RU/mL, II: 15·8 RU/mL, III/IV: 38·8 RU/mL; P < 0·001). Ct-FGF23 correlated with NTproBNP (r = 0·307, P < 0·001), central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and inversely correlated with cardiac output after adjustment for renal function (eGFR) and Pi . LnCt-FGF23 was related with the combined endpoint of death or heart transplantation (hazard ratio 1·452 [1·029-2·048]; P = 0·034) independent of Pi , PTH, 25(OH)D, age and sex. CONCLUSION The phosphatonin FGF23 is strongly associated with disease severity and long-term outcome in patients with nonischaemic heart failure and preserved renal function. Further studies are needed to evaluate the pathophysiologic role of FGF23 and its potential as a biomarker in heart failure.
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Affiliation(s)
- Gerhard Poelzl
- Clinical Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria
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Sugimoto T, Dohi K, Onishi K, Yamada T, Horiguchi M, Takamura T, Kawamura A, Seko T, Nakamura M, Kasai A, Ito M. Prognostic value of serum parathyroid hormone level in acute decompensated heart failure. Circ J 2014; 78:2704-10. [PMID: 25253620 DOI: 10.1253/circj.cj-14-0481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism develops as a compensatory response to chronic heart failure (HF) and renal failure. The role of parathyroid hormone (PTH) level in acute decompensated HF remains unclear. The aim of this study was therefore to investigate the relationships among mortality, renal function, and serum PTH level in acute decompensated HF patients. METHODS AND RESULTS: A total of 266 consecutive patients admitted for acute decompensated HF without acute coronary syndrome (78±12 years; 48% male) were enrolled. Demographic, clinical, and laboratory characteristics were obtained on admission.During 1-year follow-up, 65 patients (24%) died. Serum PTH level on admission was within the normal range (10-65 pg/ml) in 108 patients (41%), of whom 39 (15%) had low-normal PTH (10-40 pg/ml). On Kaplan-Meier analysis all-cause mortality was significantly higher in patients with low-normal PTH than in those with high-normal (40-65 pg/ml) or high (>65 pg/ml) PTH (log-rank test). On univariate and multivariate Cox regression analysis, low-normal PTH was significantly associated with increased all-cause mortality (unadjusted HR, 2.88; 95% CI: 1.69-4.91; P<0.001; adjusted HR, 3.84; 95% CI: 1.54-9.57; P=0.004). CONCLUSIONS In patients with acute decompensated HF resulting in hospitalization, low-normal PTH on admission is associated with increased all-cause mortality, regardless of renal function.
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Wannamethee SG, Welsh P, Papacosta O, Lennon L, Whincup PH, Sattar N. Elevated parathyroid hormone, but not vitamin D deficiency, is associated with increased risk of heart failure in older men with and without cardiovascular disease. Circ Heart Fail 2014; 7:732-9. [PMID: 25104043 DOI: 10.1161/circheartfailure.114.001272] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/28/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hyperparathyroidism and low vitamin D status have been implicated in the pathogenesis of heart failure (HF). We examined the prospective associations between parathyroid hormone (PTH), circulating 25-hydroxyvitamin D, and markers of mineral metabolism and risk of incident HF in older men with and without established cardiovascular disease. METHODS AND RESULTS Prospective study of 3731 men aged 60 to 79 years with no prevalent HF followed up for a mean period of 13 years, in whom there were 287 incident HF cases. Elevated PTH (≥55.6 pg/mL; top quarter) was associated with significantly higher risk of incident HF after adjustment for lifestyle characteristics, diabetes mellitus, blood lipids, blood pressure, lung function, heart rate, renal dysfunction, atrial fibrillation, forced expiratory volume in 1 second, and C-reactive protein (hazards ratio, 1.66; 95% confidence interval, 1.30-2.13). The increased risk was seen in both men with and without previous myocardial infarction or stroke (hazards ratio, 1.72; 95% confidence interval, 1.07-2.76; hazards ratio, 1.70; 95% confidence interval, 1.25-2.30, respectively). Elevated PTH was significantly associated with N-terminal probrain natriuretic peptide, a marker of left ventricular wall stress. By contrast, 25-hydroxyvitamin D and other markers of mineral metabolism including serum calcium and phosphate showed no significant association with incident HF after adjustment for age. CONCLUSIONS Elevated PTH, but not 25-hydroxyvitamin D or other markers of mineral metabolism, is associated with increased risk of HF in both older men with and without myocardial infarction/stroke. This increased risk was not explained by its association with known risk factors for HF. Further studies are now needed to elucidate the mechanisms underlying this association.
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Affiliation(s)
- S Goya Wannamethee
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
| | - Paul Welsh
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Olia Papacosta
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Lucy Lennon
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Peter H Whincup
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
| | - Naveed Sattar
- From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.)
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Pfister R, Michels G, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Low bone mineral density predicts incident heart failure in men and women: the EPIC (European Prospective Investigation into Cancer and Nutrition)-Norfolk prospective study. JACC-HEART FAILURE 2014; 2:380-9. [PMID: 25023816 DOI: 10.1016/j.jchf.2014.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/07/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES It is unknown whether bone mineral density as a measure of osteoporosis is associated with development of heart failure. BACKGROUND Recent evidence suggests shared risk factors between heart failure and osteoporosis. Additionally, patients with osteoporosis are at increased risk for cardiovascular disease. METHODS We examined the prospective association of bone mineral density measured as broadband ultrasound attenuation by quantitative ultrasound of the heel with incident heart failure events in 13,666 apparently healthy persons 42 to 82 years of age participating in the EPIC (European Prospective Investigation into Cancer and Nutrition) study in Norfolk, United Kingdom. RESULTS During a mean follow-up of 9.3 years, 380 incident cases of heart failure occurred. The risk of heart failure decreased with increasing bone mineral density. The hazard ratios comparing each quartile with the lowest were 0.40 (95% confidence intervals [CI]: 0.27 to 0.59), 0.54 (95% CI: 0.37 to 0.79), and 0.46 (95% CI: 0.32 to 0.68) in analysis adjusting for age, sex, smoking, alcohol consumption, physical activity, occupational social class, educational level, systolic blood pressure, diabetes, cholesterol concentration, and body mass index (p for trend = 0.002), with a 23% risk decrease associated with every increase in 1 standard deviation of bone mineral density (hazard ratio [HR]: 0.77; 95% CI: 0.66 to 0.89). The association was stronger with heart failure without (HR: 0.75; 95% CI: 0.63 to 0.89) than with antecedent myocardial infarction (HR: 0.82; 95% CI: 0.62 to 1.09). CONCLUSIONS We observed an inverse association between bone mineral density and the risk of heart failure in apparently healthy individuals. Our findings give support for cardiac assessment in people with reduced bone mineral density and warrant further exploration of underlying biological mechanisms linking osteoporosis and heart failure.
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Affiliation(s)
- Roman Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany.
| | - Guido Michels
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany
| | - Stephen J Sharp
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Nick J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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Hassan M, Qureshi W, Sroujieh LS, Albashaireh D, BouMalham S, Liroff M, Amjad W, Khalid F, Hadid H, Alirhayim Z. Interplay of parathyroid hormone and aldosterone antagonist in prevention of heart failure hospitalizations in chronic kidney disease. J Renin Angiotensin Aldosterone Syst 2014; 15:278-85. [PMID: 25002131 DOI: 10.1177/1470320314539180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Aldosterone antagonists may mediate their effects on heart failure through parathyroid hormone (PTH) in chronic kidney disease (CKD) patients. METHODS Patients with CKD on spironolactone were selected and matched for age, gender, race, use of a vitamin D analogue, the number of antihypertensive medications, and CKD stage. PTH levels before and after the first prescription of spironolactone were measured. A thorough chart review was conducted to assess for heart failure hospitalizations. An adjusted Cox proportional model was used to calculate the hazard ratio (HR) for heart failure hospitalizations among cases versus controls. RESULTS There were a total of 950 (mean age 67±13 years, 40% men) patients with CKD. Of these, there were 48 hospitalizations for heart failure among the cases and 82 among the controls (HR 0.37; 95% confidence interval (CI) 0.19-0.74, p=0.005). We noted a more significant decrease in PTH levels among the cases when compared to the controls (p<0.0001). The adjusted hazard for heart failure hospitalization increased with higher PTH levels (p=0.002) and mediation analysis revealed change in PTH level as a significant mediator of heart failure hospitalization (p=0.04). CONCLUSION Aldosterone antagonists may be helpful in preventing hospitalizations for heart failure exacerbation in CKD patients through a PTH-mediated effect.
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Affiliation(s)
- Mona Hassan
- Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA
| | - Waqas Qureshi
- Section of Cardiology, Wake Forest School of Medicine, USA
| | - Laila S Sroujieh
- Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA
| | - Derar Albashaireh
- Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA
| | - Sara BouMalham
- Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA
| | - Meghan Liroff
- Department of Emergency Medicine, Henry Ford Hospital/Wayne State University, USA
| | | | - Fatima Khalid
- Section of Nephrology and Hypertension, Wake Forest School of Medicine, USA
| | - Hiba Hadid
- Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA
| | - Zaid Alirhayim
- Division of Cardiovascular Diseases, University of Kansas Medical Center, USA
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Hagström E, Michaëlsson K, Melhus H, Hansen T, Ahlström H, Johansson L, Ingelsson E, Sundström J, Lind L, Ärnlöv J. Plasma–Parathyroid Hormone Is Associated With Subclinical and Clinical Atherosclerotic Disease in 2 Community-Based Cohorts. Arterioscler Thromb Vasc Biol 2014; 34:1567-73. [DOI: 10.1161/atvbaha.113.303062] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Cardiovascular risk factors have different impact on different arterial territories. Diseases with elevated circulating parathyroid hormone (PTH) such as primary hyperparathyroidism and chronic renal failure have been shown to be associated with an increased risk of cardiovascular disease, predominantly heart or cerebrovascular diseases. However, data on the associations between circulating PTH and peripheral atherosclerosis are limited.
Approach and Results—
Two prospective, community-based studies were used. In 306 men and women, who were 70 years old, from the Prospective investigation of the vasculature in Uppsala seniors (PIVUS) study, cross-sectional relations between PTH and atherosclerotic burden assessed by whole-body magnetic resonance angiography were investigated. In 998 men, who were 71 years old, from the Uppsala longitudinal study of adult men (ULSAM) study, the association between PTH concentration and risk of subsequent nonfatal atherosclerotic disease (excluding coronary or cerebrovascular disease) was investigated. Adjusting for established vascular risk factors, PTH was associated with burden of atherosclerosis (increase in total atherosclerotic score per SD PTH increase: 0.04, 0.003–0.08;
P
=0.03) in the PIVUS study. During follow-up in the ULSAM study (median 16.7 years), 89 men were diagnosed with nonfatal atherosclerotic disease. In Cox-regression analyses adjusting for established vascular risk factors and mineral metabolism, higher PTH was associated with an increased risk of nonfatal atherosclerotic disease (hazard ratio for 1 SD increase of PTH: 1.55, 1.33–1.88;
P
<0.0001). Results were similar when including fatal atherosclerotic disease in the outcome.
Conclusions—
In 2 independent community-based cohorts, PTH was associated to the degree of atherosclerosis and risk of clinically overt atherosclerotic disease, respectively. Our data confirm and extend previous studies supporting a role for PTH in the development of atherosclerotic disease.
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Affiliation(s)
- Emil Hagström
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Karl Michaëlsson
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Håkan Melhus
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Thomas Hansen
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Håkan Ahlström
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Lars Johansson
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Erik Ingelsson
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Johan Sundström
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Lars Lind
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Johan Ärnlöv
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
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Stompór T. Coronary artery calcification in chronic kidney disease: An update. World J Cardiol 2014; 6:115-129. [PMID: 24772252 PMCID: PMC3999332 DOI: 10.4330/wjc.v6.i4.115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/10/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Arterial calcification is a well-recognized complication of advanced atherosclerosis. Chronic kidney disease (CKD) is characterized by significantly more pronounced, disseminated and fast-progressing calcification of the vascular system, including the coronary arteries. New computed tomography-based imaging techniques allow for the noninvasive assessment and monitoring of calcification in different vascular sites. Coronary artery calcification (CAC) develops early in the course of CKD and is tightly associated with mineral and bone disorders, which include but are not limited to secondary hyperparathyroidism. In this review, recent data on the pathogenesis of CAC development and progression are discussed, with a special emphasis on fibroblast growth factor 23 and its co-receptor, klotho. The prevalence, progression and prognostic significance of CAC are reviewed separately for patients with end-stage renal disease treated with dialysis, kidney transplant recipients and patients with earlier stages of CKD. In the last section, therapeutic considerations are discussed, with special attention paid to the importance of treatment that addresses mineral and bone disorders of CKD.
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Gruson D, Buglioni A, Burnett JC. PTH: Potential role in management of heart failure. Clin Chim Acta 2014; 433:290-6. [PMID: 24704306 DOI: 10.1016/j.cca.2014.03.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/23/2014] [Accepted: 03/25/2014] [Indexed: 01/10/2023]
Abstract
Biomarkers play an important role for the diagnosis and prognosis of heart failure (HF), a disease with high morbidity and mortality as well as a huge impact on healthcare budgets. Parathyroid hormone (PTH) is a major systemic calcium-regulating hormone and an important regulator of bone and mineral homeostasis. PTH testing is important for differential diagnosis of calcemia related disorders and for the management of patients with chronic kidney disease. As secondary hyperparathyroidism has been evidenced in HF patients, PTH testing might be relevant in HF patients for risk stratification and more personalized selection of treatment.
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Affiliation(s)
- D Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium; Department of Laboratory Medicine, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - A Buglioni
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA
| | - J C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA
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Abstract
Secondary hyperparathyroidism in heart failure is a consequence of renin-angiotensin-aldosterone activation, chronic hyperaldosteronism, and loop diuretic usage, resulting in calcium excretion. The result is an inflammatory state with adverse effects on myocardial remodeling and systemic complications. Recent literature has suggested that elevated parathyroid hormone predicts adverse outcomes in patients with heart failure independent of serum calcium and phosphate, vitamin D deficiency, and renal insufficiency. Parathyroid hormone has been correlated with elevated brain natriuretic peptide levels, an established biomarker of heart failure severity. There are several limitations to the utilization of parathyroid hormone as a biomarker for heart failure, and further prospective studies need to be conducted to assess the value of multiple parathyroid hormone measurements over time and elucidate the role of parathyroid hormone in diastolic dysfunction. Pending further validation, there is promise for parathyroid hormone as a complementary biomarker in heart failure.
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di Giuseppe R, Buijsse B, Hirche F, Wirth J, Arregui M, Westphal S, Isermann B, Hense HW, Dierkes J, Boeing H, Stangl GI, Weikert C. Plasma fibroblast growth factor 23, parathyroid hormone, 25-hydroxyvitamin D3, and risk of heart failure: a prospective, case-cohort study. J Clin Endocrinol Metab 2014; 99:947-55. [PMID: 24423292 DOI: 10.1210/jc.2013-2963] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Bone mineral metabolism may play a role in the development of heart failure (HF). OBJECTIVE The aim of the study was to investigate the relationships of plasma fibroblast growth factor (FGF) 23, PTH, and 25-hydroxyvitamin D3 [25(OH)D3] with incident congestive HF in a population-based cohort of men and women aged 40-65 and 35-65 years, respectively, at baseline. DESIGN We conducted a prospective case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, including a randomly drawn sample of the total cohort free of HF and all incident HF cases that occurred during a mean follow-up of 8.2 ± 1.6 years. PARTICIPANTS AND SETTING A total of 221 incident congestive HF cases and 1228 individuals free of HF were included in the study. MAIN OUTCOME MEASURES Incident congestive HF was measured. RESULTS In a multivariable model, each doubling of FGF23 [ie, per log (base 2) unit higher FGF23] was associated with a 29% higher HF risk (hazard ratio, 1.29 [95% confidence interval (CI), 1.07-1.56]). After multivariable adjustment, including estimated glomerular filtration rate, PTH was not related to HF risk (hazard ratio per doubling of PTH, 1.21 [95% CI, 0.99-1.48]). However, an interaction was observed between PTH and obesity, suggesting a relationship with HF risk in obese, but not in nonobese individuals. The hazard ratio for HF per doubling of 25(OH)D3 was 1.02 (95% CI, 0.73-1.41). CONCLUSIONS Our findings provide epidemiological evidence for a positive relationship between FGF23 and risk of HF. The role of PTH in the development of HF remains unclear, in particular in obese individuals, until further confirmation in other studies. 25(OH)D3 was not related to HF.
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Affiliation(s)
- Romina di Giuseppe
- Department of Epidemiology (R.d.G., B.B., J.W., M.A., H.B., C.W.), German Institute of Human Nutrition Potsdam-Rehbrücke, D-14558 Nuthetal, Germany; Institute of Agricultural and Nutritional Sciences (F.H., G.I.S.), Human Nutrition Group, Martin-Luther-University Halle-Wittenberg, D-06108 Halle, Germany; Department for Clinical Chemistry and Pathobiochemistry (S.W., B.I.), Otto-von-Guericke-University Magdeburg, 39106 Magdeburg, Germany; Institute of Epidemiology and Social Medicine (H.W.H.), Clinical Epidemiology Unit, University of Münster, D-48129 Münster, Germany; Department of Clinical Medicine (J.D.), University of Bergen, N-5020 Bergen Norway; and Institute for Social Medicine, Epidemiology, and Health Economics (C.W.), Charité University Medical Center, 10117 Berlin, Germany
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Liu LC, Voors AA, van Veldhuisen DJ, van der Veer E, Belonje AM, Szymanski MK, Silljé HH, van Gilst WH, Jaarsma T, de Boer RA. Vitamin D status and outcomes in heart failure patients. Eur J Heart Fail 2014; 13:619-25. [DOI: 10.1093/eurjhf/hfr032] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Licette C.Y. Liu
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Adriaan A. Voors
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Dirk J. van Veldhuisen
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Eveline van der Veer
- Department of Laboratory Medicine; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Anne M. Belonje
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Mariusz K. Szymanski
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Herman H.W. Silljé
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Wiek H. van Gilst
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Tiny Jaarsma
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Hanzeplein 1, PO Box 30.001, 9700 RB Groningen The Netherlands
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Abstract
This review discusses recent findings on the clinical presentation, evaluation, medical and surgical management of primary hyperparathyroidism. Medical management includes the use of cinacalcet and bisphosphonates for bone loss and correction of vitamin D deficiency. Surgical updates reviewed recent studies on the preoperative localization of the disease, specifically, sestamibi scans, 4DCT and MRI. Focused parathyroidectomy continues to be the preferred surgical approach for a select group of patients, guided by intraoperative use of PTH and new technology, such as endoscopic and robotic platforms; however, there appears to be no difference in long-term success compared to the traditional approach.
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Affiliation(s)
- Zeina Habib
- a Mercy Hospital and Medical Center - Internal Medicine, Section of Endocrinology and Metabolism, 2525 S Michigan Ave, Chicago, IL 60616, USA
| | - Adam Kabaker
- b Loyola University - Surgery, Section of Endocrine Surgery, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Pauline Camacho
- c Loyola University - Endocrinology and Metabolism, 2160 S. First Avenue, Maywood, IL 60153, USA
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Inomata T. Parathyroid Hormone in Heart Failure. Circ J 2014; 78:2631-2. [DOI: 10.1253/circj.cj-14-1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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Abstract
Patients with chronic kidney disease are at increased risk for progressing to end-stage renal disease, developing cardiovascular disease, and dying prematurely. Recent evidence has suggested that disordered mineral metabolism, which includes hyperphosphatemia, secondary hyperparathyroidism, vitamin D deficiency, and fibroblast growth factor 23 excess, may contribute to the high rates of adverse outcomes in this population. However, marked within-subject variability for some of these biochemical parameters exists, potentially detracting from the utility of certain metabolites as prognostic tools. This review summarizes the available data on the epidemiology of phosphate, parathyroid hormone, vitamin D, and fibroblast growth factor 23, and their relationships with adverse clinical outcomes in chronic kidney disease, compares the performance of each as a biomarker of risk and introduces recent insights into the pathophysiology behind some of the observed relationships.
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Abstract
The symptoms and signs constituting the congestive heart failure (CHF) syndrome have their pathophysiologic origins rooted in a salt-avid renal state mediated by effector hormones of the renin-angiotensin-aldosterone and adrenergic nervous systems. Controlled clinical trials, conducted over the past decade in patients having minimally to markedly severe symptomatic heart failure, have demonstrated the efficacy of a pharmacologic regimen that interferes with these hormones, including aldosterone receptor binding with either spironolactone or eplerenone. Potential pathophysiologic mechanisms, which have not hitherto been considered involved for the salutary responses and cardioprotection provided by these mineralocorticoid receptor antagonists, are reviewed herein. In particular, we focus on the less well-recognized impact of catecholamines and aldosterone on monovalent and divalent cation dyshomeostasis, which leads to hypokalemia, hypomagnesemia, ionized hypocalcemia with secondary hyperparathyroidism and hypozincemia. Attendant adverse cardiac consequences include a delay in myocardial repolarization with increased propensity for supraventricular and ventricular arrhythmias, and compromised antioxidant defenses with increased susceptibility to nonischemic cardiomyocyte necrosis.
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Delanaye P, Krzesinski JM, Cavalier E. EVOLVE : entre déception et optimisme. Nephrol Ther 2013; 9:241-5. [DOI: 10.1016/j.nephro.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/06/2013] [Indexed: 11/15/2022]
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van Ballegooijen AJ, Reinders I, Visser M, Brouwer IA. Parathyroid hormone and cardiovascular disease events: A systematic review and meta-analysis of prospective studies. Am Heart J 2013; 165:655-64, 664.e1-5. [PMID: 23622902 DOI: 10.1016/j.ahj.2013.02.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Parathyroid hormone (PTH) excess might play a role in cardiovascular health. We therefore conducted a systematic review and meta-analysis to evaluate the association between PTH and cardiovascular disease (CVD) events, and intermediate outcomes. METHODS We conducted a systematic and comprehensive database search using MEDLINE and Embase between 1947 and October 2012. We included English-language prospective studies that reported risk estimates for PTH and CVD events, and intermediate outcomes. The characteristics of study populations, exposure, and outcomes of total CVD events, fatal and non-fatal CVD events were reported, and a quality assessment was conducted. Results were extracted for the highest versus lowest PTH concentrations, and meta-analyses were carried out using random effects models. RESULTS The systematic literature search yielded 5770 articles, and 15 studies were included. Study duration ranged between 2 and 14 years. All studies were performed primarily in whites with a mean age between 55 and 75 years. The meta-analyses included 12 studies, of which 10 investigated total CVD events; 7, fatal CVD events; and 3, non-fatal CVD events. PTH excess indicated an increased risk for total CVD events: pooled HR (95% CI), 1.45 (1.24-1.71). The results for fatal CVD events and non-fatal CVD events were: HR 1.50 (1.18-1.91) and HR 1.48 (1.14-1.92). Heterogeneity was moderately present; however, sensitivity analyses for follow-up duration, prior CVD, or PTH as dichotomous values showed similar results. CONCLUSIONS The meta-analysis indicates that higher PTH concentrations are associated with increased risk of CVD events.
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van Ballegooijen AJ, Reinders I, Visser M, Dekker JM, Nijpels G, Stehouwer CDA, Pilz S, Brouwer IA. Serum parathyroid hormone in relation to all-cause and cardiovascular mortality: the Hoorn study. J Clin Endocrinol Metab 2013; 98:E638-45. [PMID: 23408568 DOI: 10.1210/jc.2012-4007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Higher PTH concentrations have been associated with fatal cardiovascular diseases (CVDs), but data in the general population are scarce. OBJECTIVE We investigated whether higher PTH concentrations are prospectively associated with all-cause and CVD mortality. DESIGN, SETTING, PARTICIPANTS This study used data from the Hoorn Study, a prospective population-based cohort with baseline measurements between 2000 and 2001. We included 633 participants, mean age 70.1 ± 6.6 years, 51% female. Serum intact PTH was measured using a 2-site immunoassay. MAIN OUTCOME MEASURES Outcomes were all-cause and CVD mortality based on clinical files and coded according to the International Classification of Diseases, ninth revision. We used Kaplan-Meier plots to estimate survival curves and Cox regression to estimate hazard ratios (HRs) using season-specific PTH quartiles. RESULTS During a median follow-up of 7.8 years, 112 participants died, of which 26 deaths (23%) were cardiovascular. Survival curves by PTH quartiles differed for all-cause mortality (log-rank P = .054) and CVD mortality (log-rank P = .022). In a multivariate model, the highest PTH quartile was associated with all-cause mortality; HR = 1.98 (1.08, 3.64). Kidney function slightly attenuated the PTH risk association, but risk persisted; HR = 1.93 (1.04, 3.58). The results for CVD mortality showed a similar pattern, although the association was significant only in a threshold model (quartile 4 vs quartile 1-3); HR = 2.56 (1.11, 5.94). CONCLUSIONS Among a general older population, higher PTH concentrations were associated with higher all-cause mortality risk, mostly explained by fatal CVD events. We suggest to evaluate whether individuals with high PTH concentrations benefit from therapeutic approaches targeted to decrease PTH concentrations.
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Affiliation(s)
- A J van Ballegooijen
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands.
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