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Zambrano A, Tintut Y, Demer LL, Hsu JJ. Potential mechanisms linking high-volume exercise with coronary artery calcification. Heart 2023; 109:1139-1145. [PMID: 36702539 PMCID: PMC10356745 DOI: 10.1136/heartjnl-2022-321986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
Recent studies have found an association between high volumes of physical activity and increased levels of coronary artery calcification (CAC) among older male endurance athletes, yet the underlying mechanisms have remained largely elusive. Potential mechanisms include greater exposure to inflammatory cytokines, reactive oxygen species and oxidised low-density lipoproteins, as acute strenuous physical activity has been found to enhance their systemic release. Other possibilities include post-exercise elevations in circulating parathyroid hormone, which can modify the amount and morphology of calcific plaque, and long-term exposure to non-laminar blood flow within the coronary arteries during vigorous physical activity, particularly in individuals with pre-existing atherosclerosis. Further, although the association has only been identified in men, the role of testosterone in this process remains unclear. This brief review discusses the association between high-volume endurance exercise and CAC in older men, elaborates on the potential mechanisms underlying the increased calcification, and provides clinical implications and recommendations for those at risk.
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Affiliation(s)
- Angelica Zambrano
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Yin Tintut
- Medicine/Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Linda L Demer
- Medicine/Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jeffrey J Hsu
- Medicine/Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Williams MJ, White SC, Joseph Z, Hruska KA. Updates in the chronic kidney disease-mineral bone disorder show the role of osteocytic proteins, a potential mechanism of the bone-Vascular paradox, a therapeutic target, and a biomarker. Front Physiol 2023; 14:1120308. [PMID: 36776982 PMCID: PMC9909112 DOI: 10.3389/fphys.2023.1120308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
The chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex multi-component syndrome occurring during kidney disease and its progression. Here, we update progress in the components of the syndrome, and synthesize recent investigations, which suggest a potential mechanism of the bone-vascular paradox. The discovery that calcified arteries in chronic kidney disease inhibit bone remodeling lead to the identification of factors produced by the vasculature that inhibit the skeleton, thus providing a potential explanation for the bone-vascular paradox. Among the factors produced by calcifying arteries, sclerostin secretion is especially enlightening. Sclerostin is a potent inhibitor of bone remodeling and an osteocyte specific protein. Its production by the vasculature in chronic kidney disease identifies the key role of vascular cell osteoblastic/osteocytic transdifferentiation in vascular calcification and renal osteodystrophy. Subsequent studies showing that inhibition of sclerostin activity by a monoclonal antibody improved bone remodeling as expected, but stimulated vascular calcification, demonstrate that vascular sclerostin functions to brake the Wnt stimulation of the calcification milieu. Thus, the target of therapy in the chronic kidney disease-mineral bone disorder is not inhibition of sclerostin function, which would intensify vascular calcification. Rather, decreasing sclerostin production by decreasing the vascular osteoblastic/osteocytic transdifferentiation is the goal. This might decrease vascular calcification, decrease vascular stiffness, decrease cardiac hypertrophy, decrease sclerostin production, reduce serum sclerostin and improve skeletal remodeling. Thus, the therapeutic target of the chronic kidney disease-mineral bone disorder may be vascular osteoblastic transdifferentiation, and sclerostin levels may be a useful biomarker for the diagnosis of the chronic kidney disease-mineral bone disorder and the progress of its therapy.
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Affiliation(s)
- Matthew J. Williams
- Division of Pediatric Nephrology, Department of Pediatrics, Washington University, Saint Louis, MO, United States,*Correspondence: Keith A. Hruska, ; Matthew J. Williams,
| | - Sarah C. White
- Division of Pediatric Nephrology, Department of Pediatrics, Washington University, Saint Louis, MO, United States
| | - Zachary Joseph
- Division of Pediatric Nephrology, Department of Pediatrics, Washington University, Saint Louis, MO, United States
| | - Keith A. Hruska
- Division of Pediatric Nephrology, Department of Pediatrics, Washington University, Saint Louis, MO, United States,Departments of Medicine and Cell Biology, Washington University, Saint Louis, MO, United States,*Correspondence: Keith A. Hruska, ; Matthew J. Williams,
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3
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Hyperparathyroidism Possibly Causing Increased Coronary Artery Calcification. Am J Cardiol 2022; 172:164-165. [PMID: 35361476 DOI: 10.1016/j.amjcard.2022.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
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4
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Volk C, Schmidt B, Brandsch C, Kurze T, Schlegelmilch U, Grosse I, Ulrich C, Girndt M, Stangl GI. Acute Effects of an Inorganic Phosphorus Additive on Mineral Metabolism and Cardiometabolic Risk Factors in Healthy Subjects. J Clin Endocrinol Metab 2022; 107:e852-e864. [PMID: 34448875 DOI: 10.1210/clinem/dgab635] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Hyperphosphatemia and high levels of fibroblast growth factor 23 (FGF23) are risk factors for cardiovascular events in patients with chronic kidney diseases. However, the impact of an inorganic phosphorus additive in healthy people is largely unknown. OBJECTIVE We aimed to investigate the acute effect of excessive dietary phosphorus administered as sodium dihydrogen phosphate on the postprandial levels of Pi and FGF23 and the response to food. METHODS This study was a double-blind placebo-controlled crossover study with 29 healthy male and female participants from the general community who were administered a single dose of either 700 mg phosphorus (NaH2PO4) or a sodium-adjusted placebo in combination with a test meal. Postprandial plasma levels of Pi and FGF23 were measured. RESULTS Compared with placebo, oral phosphorus increased the plasma Pi level, which remained elevated during the ensuing 8 hours (at 480 minutes: 1.31 vs 1.16 mmol/l; P < 0.001), increased urinary Pi (iAUC0-480 789 vs 95 mmol/mmol; P < 0.001), reduced tubular Pi reabsorption (iAUC0-480 -31.5 vs -6.2; P < 0.001), decreased urinary calcium (iAUC0-240 30.6 vs 53.0 mmol/mmol; P = 0.009), and stimulated the release of parathyroid hormone (iAUC0-480 2212 vs 768 ng/l; P < 0.001). However, the FGF23 levels did not change. Postprandial levels of glucose, insulin, and lipids were not substantially affected by phosphorus vs placebo. CONCLUSION An oral phosphorus load can induce elevated postprandial levels of circulating Pi for hours in healthy subjects, despite rapid homeostatic counterreactions. FGF23 levels and the postprandial response to food were not affected.
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Affiliation(s)
- Christin Volk
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Benjamin Schmidt
- Institute of Computer Science, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Corinna Brandsch
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Tabea Kurze
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Ulf Schlegelmilch
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Ivo Grosse
- Institute of Computer Science, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
- Competence Cluster of Cardiovascular Health and Nutrition (nutriCARD), Halle-Jena-Leipzig, Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Germany
| | - Christof Ulrich
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Gabriele I Stangl
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
- Institute of Computer Science, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Greer ML, Davis K, Stack BC. Machine learning can identify patients at risk of hyperparathyroidism without known calcium and intact parathyroid hormone. Head Neck 2021; 44:817-822. [PMID: 34953008 DOI: 10.1002/hed.26970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To prove the concept of diagnosing primary hyperparathyroidism (pHPT) without calcium and parathyroid hormone (PTH) values and identifying potential risk factors for pHPT. METHODS Data were extracted from the clinical data warehouse (CDW) at the University of Arkansas for Medical Sciences (UAMS) Epic EHR (2014-2019). RESULTS 1737 patients with over 185 000 rows of clinical data were provided in a relational structure and processed/flattened to facilitate modeling. Phenotype elements were identified for pHPT without advance knowledge of calcium and PTH levels. The area under the curve (AUC) for the prediction of pHPT using our model was 0.86 with sensitivity and specificity of 0.8953 and 0.6686, respectively, using a 0.45 probability threshold. CONCLUSION Primary hyperparathyroidism was predicted from a dataset excluding calcium and PTH data with 86% accuracy. This approach needs to be validated/refined on larger samples of data and plans are in place to do this with other regional/national datasets.
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Affiliation(s)
- Melody L Greer
- Department of Health Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kyle Davis
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Angoff R, Mosarla RC, Tsao CW. Aortic Stiffness: Epidemiology, Risk Factors, and Relevant Biomarkers. Front Cardiovasc Med 2021; 8:709396. [PMID: 34820427 PMCID: PMC8606645 DOI: 10.3389/fcvm.2021.709396] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
Aortic stiffness (AoS) is a maladaptive response to hemodynamic stress and both modifiable and non-modifiable risk factors, and elevated AoS increases afterload for the heart. AoS is a non-invasive marker of cardiovascular health and metabolic dysfunction. Implementing AoS as a diagnostic tool is challenging as it increases with age and varies amongst races. AoS is associated with lifestyle factors such as alcohol and smoking, as well as hypertension and comorbid conditions including metabolic syndrome and its components. Multiple studies have investigated various biomarkers associated with increased AoS, and this area is of particular interest given that these markers can highlight pathophysiologic pathways and specific therapeutic targets in the future. These biomarkers include those involved in the inflammatory cascade, anti-aging genes, and the renin-angiotensin aldosterone system. In the future, targeting AoS rather than blood pressure itself may be the key to improving vascular health and outcomes. In this review, we will discuss the current understanding of AoS, measurement of AoS and the challenges in interpretation, associated biomarkers, and possible therapeutic avenues for modulation of AoS.
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Affiliation(s)
- Rebecca Angoff
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ramya C Mosarla
- Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Alatič J, Lindič J, Godnov U, Kovač D. Arterial Stiffness in Renal Transplant Recipients: 5-Year Follow-up. Transplant Proc 2021; 53:2907-2912. [PMID: 34772493 DOI: 10.1016/j.transproceed.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic kidney disease is a risk factor for cardiovascular diseases. After renal transplant, some traditional and chronic kidney disease-specific risk factors vanish, but new risk factors emerge. This retrospective study aimed to define the long-term impact of renal transplant and diabetes mellitus on arterial stiffness, evaluated by measuring pulse wave velocity (PWV) and augmentation index (AI) and on myocardial perfusion, evaluated by subendocardial viability ratio (SEVR). METHODS PWV, AI, and SEVR were evaluated noninvasively by applanation tonometry using SphygmoCor in the first 4 weeks after kidney transplant and 4 to 5 years thereafter. RESULTS A total of 48 graft recipients (18 women, 30 men; mean ± standard deviation age, 47.9 ± 11.8 years) were included. The follow-up period was 57.4 ± 8.0 months. PWV did not change significantly during the follow-up period (9.1 ± 1.8m/s and 8.7 ± 1.8m/s, respectively; P = .137). In the subgroup of patients without diabetes mellitus, we observed a trend of PWV reduction, whereas in the subgroup of patients with diabetes we observed the trend of PWV increase. The duration of smoking before transplant correlated significantly with PWV (P = .012). AI in the whole group increased significantly during the study period (from 18.3% ±10.3% to 25.9% ±9.4%; P < .01) as well as SEVR (from 134.9 ± 23.1 to 155.4 ± 28.6; P = .001). CONCLUSIONS PWV, reflecting the central vessel stiffness, did not change significantly in the whole group during the follow-up period. The AI, which indicates systemic stiffness, increased significantly within 5 years after transplant, indicating the progression of vascular processes of elastic and muscular arteries. Significant increases in the SEVR values in both diabetics and nondiabetics indicate the long-term favorable effect of kidney transplant on myocardial perfusion.
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Affiliation(s)
- Jan Alatič
- University Medical Centre Ljubljana, Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia
| | - Jelka Lindič
- University Medical Centre Ljubljana, Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia
| | - Uroš Godnov
- Department of Computer Science, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Damjan Kovač
- University Medical Centre Ljubljana, Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia.
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Radial BMD and serum CTX-I can predict the progression of carotid plaque in rheumatoid arthritis: a 3-year prospective cohort study. Arthritis Res Ther 2021; 23:258. [PMID: 34641970 PMCID: PMC8513174 DOI: 10.1186/s13075-021-02642-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) are almost twice as likely to develop cardiovascular disease (CVD) as those without. However, traditional CVD risks have been shown to underperform in RA patients; thus, we aimed to identify new surrogate risk factors to better reflect their atherosclerotic burden. METHODS A total of 380 RA patients with carotid atherosclerosis data were analyzed in this prospective cohort study. The primary outcome was carotid plaque progression over the 3-year follow-up period. Risk parameters assessed for the progression of carotid plaque were categorized as demographics, traditional CVD risks, RA-related risks, and bone parameters. RESULTS The progression of carotid plaque was associated with the level of rheumatoid factor (p = 0.025), serum C-terminal telopeptide of type-I collagen (CTX-I) (p = 0.014), and femur and distal radius bone mass density (BMD) (p = 0.007 and 0.004, respectively), as well as traditional CVD risk factors. In multivariable analyses, the bone parameters of serum CTX-I and distal radius BMD proved to be independent predictors of the progression of carotid plaque along with hyperlipidemia, smoking, and baseline carotid plaque (all, p < 0.05). Adding both serum CTX-I and distal radius BMD increased the carotid plaque progression prediction model's percentage of explained variance from 24 to 30%. CONCLUSION High serum CTX-I and lower radius BMD, reflecting high bone turnover, were independent risk factors for the progression of carotid plaque in RA patients, implicating the direct or indirect role of bone metabolism on the atherosclerotic burden.
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Zaki HM, Sliem HA, Ibrahim HR, Yassine IA. Silent neurological lesions detected by magnetic resonance imaging: Relationship to hyperparathyroidism among end-stage renal disease young patients on haemodialysis. Int J Clin Pract 2021; 75:e14569. [PMID: 34165847 DOI: 10.1111/ijcp.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) patients on haemodialysis (HD) suffer from several peripheral and central neurological complications. They are at high risk for developing silent neurological lesions (SNL) that may be detected accidentally by magnetic resonance imaging (MRI). Many factors are implicated in the development of neurological deficits in ESRD patients on HD. AIM OF THE WORK Evaluation of SNL in young ESRD patients by using MRI and assessing its correlation with hyperparathyroidism. METHODS The study involved 48 young ESRD patients (mean age of 19.6 ± 6 years) with HD and do not have any apparent abnormalities in the neurological examination. Laboratory investigations and conventional brain MRI were done on all. RESULTS 79.2% have SBI and 45.8% have white matter lesions. Regression analysis revealed that calcium level and duration of dialysis were independent predictor factors for the presence of silent brain MRI lesions (P = .034 & 0.045 respectively). ROC curve showed that parathyroid hormone (PTH) level >585 pg/mL, duration of dialysis >2 years, and calcium level >7.5 mg/dL predicted the presence of SNL. CONCLUSION The duration of HD and hyperparathyroidism (HPT) were independent predictors for the presence of SNL. MRI brain is considered as a mandatory affordable tool for HD patients >2 years and has HPT for early detection of SNL to help early intervention and avoid neurological complications and disabilities.
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Affiliation(s)
- Heba M Zaki
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hamdy A Sliem
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba R Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Imane A Yassine
- Department of Neurology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Association of Serum Parathyroid Hormone Levels With All-Cause and Cause-Specific Mortality Among U.S. Adults. Endocr Pract 2021; 28:70-76. [PMID: 34563702 DOI: 10.1016/j.eprac.2021.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine whether parathyroid hormone (PTH) is associated with mortality among U.S. adults. METHODS This study included 8286 U.S. adults aged ≥20 years with a measurement of serum intact PTH from the National Health and Nutrition Examination Survey 2003-2006 linked to national mortality data through 2015. Multivariable Cox proportional hazard regression models were employed to estimate the adjusted hazard ratio (aHR) of all-cause and cause-specific (cardiovascular and cancer) mortality according to intact PTH levels (low or low-normal, <38; middle-normal, 38-56; high-normal, 57-74; high, >74 pg/mL). We also stratified the analyses by serum albumin-adjusted calcium and 25-hydroxy vitamin D (25OHD) levels. RESULTS During a median follow-up of 10.1 years, the mean age was 49 years, and 48% were men. After adjusting for potential confounders, both the high-normal and high PTH groups showed higher risks of all-cause mortality than the low or low-normal PTH group (high-normal PTH, aHR, 1.28; 95% confidence interval [CI], 1.10-1.48; high PTH, aHR, 1.42; 95% CI, 1.19-1.69]. When stratified by calcium and 25OHD levels, the association between high PTH and mortality was also found among participants with albumin-adjusted calcium levels of ≥9.6 mg/dL (aHR, 1.53; 95% CI, 1.17-2.01) and those with 25OHD levels of ≥20 ng/mL (aHR, 1.46, 95% CI, 1.17-1.82). We found no evidence of the increased cause-specific mortality risks in the high PTH group. CONCLUSION Higher PTH levels were associated with an increased risk of all-cause mortality, particularly among participants with albumin-adjusted calcium levels of ≥9.6 mg/dL or 25OHD levels of ≥20 ng/mL.
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Sung KC, Hong YS, Lee JY, Lee SJ, Chang Y, Ryu S, Zhao D, Cho J, Guallar E, Lima JAC. Physical activity and the progression of coronary artery calcification. Heart 2021; 107:1710-1716. [PMID: 34544807 DOI: 10.1136/heartjnl-2021-319346] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association of physical activity with the development and progression of coronary artery calcium (CAC) scores has not been studied. This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults. METHODS Prospective cohort study of men and women free of overt cardiovascular disease who underwent comprehensive health screening examinations between 1 March 2011 and 31 December 2017. Baseline physical activity was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active and health-enhancing physically active (HEPA)). The primary outcome was the difference in the 5-year change in CAC scores by physical activity category at baseline. RESULTS We analysed 25 485 participants with at least two CAC score measurements. The proportions of participants who were inactive, moderately active and HEPA were 46.8%, 38.0% and 15.2%, respectively. The estimated adjusted average baseline CAC scores (95% confidence intervals) in participants who were inactive, moderately active and HEPA were 9.45 (8.76, 10.14), 10.20 (9.40, 11.00) and 12.04 (10.81, 13.26). Compared with participants who were inactive, the estimated adjusted 5-year average increases in CAC in moderately active and HEPA participants were 3.20 (0.72, 5.69) and 8.16 (4.80, 11.53). Higher physical activity was association with faster progression of CAC scores both in participants with CAC=0 at baseline and in those with prevalent CAC. CONCLUSION We found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.
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Affiliation(s)
- Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Yun Soo Hong
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Seung-Jae Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea (the Republic of).,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of).,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea (the Republic of)
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea (the Republic of).,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of).,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea (the Republic of)
| | - Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Liu CT, Hsu SC, Hsieh HL, Chen CH, Chen CY, Sue YM, Lin FY, Shih CM, Shiu YT, Huang PH. Parathyroid Hormone Induces Transition of Myofibroblasts in Arteriovenous Fistula and Increases Maturation Failure. Endocrinology 2021; 162:6153466. [PMID: 33640969 DOI: 10.1210/endocr/bqab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Arteriovenous fistula (AVF) maturation failure remains a clinical dilemma, and its pathobiology is largely unclear. Secondary hyperparathyroidism is a complication of chronic renal failure that is associated with cardiovascular disease. While parathyroid hormone (PTH) has a prosclerotic effect on vascular smooth muscle cells (VSMCs), its role in AVF maturation failure remained unknown. OBJECTIVE This work aimed to investigate the association between plasma PTH and AVF maturation. METHODS Patients receiving AVF creation were enrolled retrospectively. A mouse model of secondary hyperparathyroidism and aortocaval AVF was used to investigate the effect of PTH on an AVF lesion. A cell model of VSMCs treated with PTH in a pressurized culture system was used to disclose the signaling pathway underlying the effect of PTH on an AVF lesion. RESULTS In patients receiving AVF creation, higher PTH was associated with an increased risk for maturation failure. In a mouse model, vascular wall thickness and myofibroblasts of AVF significantly increased with higher PTH. When the same mice were treated with cinacalcet, AVF lesions were attenuated by suppression of PTH. A cell model showed that PTH increased the marker of myofibroblasts, integrin β6 subunit (ITGB6), via the phosphorylated protein kinase B pathway. Finally, in the same model of mice AVF, higher PTH also increased the expression of ITGB6 in the smooth muscle layer of AVF, suggesting the transition to myofibroblast. CONCLUSION Overall, our results suggest that higher PTH increased the risk of AVF maturation failure through increasing the transition of VSMCs to myofibroblasts. Lowering PTH may be a strategy to enhance AVF maturation.
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Affiliation(s)
- Chung-Te Liu
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei City 110, Taiwan
| | - Shih-Chang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Hui-Ling Hsieh
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Cheng-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei City 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Chun-You Chen
- Department of Radiation Oncology, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
| | - Yuh-Mou Sue
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei City 110, Taiwan
| | - Feng-Yen Lin
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Chun-Ming Shih
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Yan-Ting Shiu
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah 84132, USA
- Veterans Affairs Medical Center, Salt Lake City, Utah 84148, USA
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City 112, Taiwan
- Cardiovascular Research Center, National Yang-Ming University, Taipei City 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan
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13
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Yavari M, Feizi A, Haghighatdoost F, Ghaffari A, Rezvanian H. The influence of parathyroidectomy on cardiometabolic risk factors in patients with primary hyperparathyroidism: a systematic review and meta-analysis. Endocrine 2021; 72:72-85. [PMID: 33057988 DOI: 10.1007/s12020-020-02519-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/02/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Primary hyperparathyroidism (PHPT) is associated with increased risk of cardiovascular morbidity and mortality. We aim to determine whether parathyroidectomy (PTX) can change cardiometabolic risk factors including serum lipids, glycemic parameters, systolic and diastolic blood pressure, C reactive protein (CRP), and body mass index (BMI). METHODS MEDLINE, Web of Science, Scopus, and Google Scholar were searched for relevant articles published till June 2020. Fixed-effect or random-effects models were used to estimate the weighted mean difference (WMD) and 95% CI for outcomes where applicable. RESULTS In total, 34 studies were eligible to be included in the current meta-analysis. Our results indicated no favorable change in serum triglyceride (n = 13, WMD = -0.06, 95% CI: -0.15, 0.03 mmol/L), total cholesterol (n = 15, WMD = 0.01, 95% CI: -0.14, 0.16 mmol/L), LDL-C (n = 10, WMD = -0.01, 95% CI: -0.17, 0.19 mmol/L), HDL-C (n = 10, WMD = 0.03, 95% CI: -0.001, 0.06 mmol/L), and CRP (n = 5, WMD = 0.82, 95% CI: -0.01, 1.64 mg/L) after PTX in PHPT patients. However, glucose (n = 24, WMD = -0.16, 95% CI: -0.26, -0.06 mmol/L), serum insulin (n = 12, WMD = -1.11, 95% CI: -1.73, -0.49 µIU/mL), systolic (n = 17, WMD = -10.14, 95% CI: -12.27, -8.01 mmHg), and diastolic (n = 16, WMD = -5.21, 95% CI: -7.0, -3.43 mmHg) blood pressures were decreased after PTX, whilst a significant increase was observed in BMI (n = 13, WMD = 0.35, 95% CI: 0.19, 0.51 kg/m2). CONCLUSIONS PTX could improve glycemic parameters and blood pressure, without any significant change in serum lipoproteins and CRP.
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Affiliation(s)
- Maryam Yavari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azin Ghaffari
- Department of Nephrology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Rezvanian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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14
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Lin TJ, Hsu BG, Wang JH, Lai YH, Dongoran RA, Liu CH. Serum indoxyl sulfate as a potential biomarker of aortic arterial stiffness in coronary artery disease. Nutr Metab Cardiovasc Dis 2020; 30:2320-2327. [PMID: 32912784 DOI: 10.1016/j.numecd.2020.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Indoxyl sulfate (IS), a dietary tryptophan metabolite, acts as a cardiotoxin and uremic toxin. High IS levels are associated with chronic kidney disease and cardiovascular diseases. This study investigated the association between serum IS levels and aortic arterial stiffness (AAS) in coronary artery disease (CAD) patients. METHODS AND RESULTS The carotid-femoral pulse wave velocity (cfPWV) was measured by the SphygmoCor system and patients with values of >10 m/s were classified in the AAS group. The baseline characteristics were recorded and measured (including biochemical and clinical data). Serum IS levels were determined using liquid chromatography-mass spectrometry. AAS occurred in 50 (34.7%) of 144 patients with CAD. They were older, had higher IS levels and percentages of diabetes, systolic blood pressure, blood urea nitrogen, and creatinine but lower estimated glomerular filtration rates. The IS level and older age significantly correlated with AAS [odds ratio (OR) = 3.834, p = 0.031; OR = 1.095, p = 0.002, respectively]. Furthermore, the serum IS level (β = 0.167, adjusted R2 change: 0.026, p = 0.027) had a significant positive correlation with cfPWV. CONCLUSIONS Taken together, higher serum IS levels are potential independent biomarkers for AAS in patients with CAD. Therefore, early checking of serum IS levels may help prevent CAD progression and have clinical implications in the near future.
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Affiliation(s)
- Tsung-Jen Lin
- Ph. D. Program in Pharmacology and Toxicology, Department of Medicine, School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan; Department of Pharmacology, Tzu Chi University, Hualien, 97004, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan; School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan; Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
| | - Yu-Hsien Lai
- Ph. D. Program in Pharmacology and Toxicology, Department of Medicine, School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan; Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
| | - Rachmad Anres Dongoran
- Ph. D. Program in Pharmacology and Toxicology, Department of Medicine, School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan; National Agency of Drug and Food Control of Republic of Indonesia, Jakarta, 10560, Indonesia; Department of Pharmacology, Tzu Chi University, Hualien, 97004, Taiwan
| | - Chin-Hung Liu
- Department of Pharmacology, Tzu Chi University, Hualien, 97004, Taiwan; CardioVascular Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan.
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15
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Secondary hyperparathyroidism is associated with postpartum blood pressure in preeclamptic women and normal pregnancies. J Hypertens 2020; 39:563-572. [PMID: 33031174 DOI: 10.1097/hjh.0000000000002638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Preeclampsia has been associated with features of secondary hyperparathyroidism. In this study, we examine the relationships of calcium metabolism with blood pressure (BP) in preeclamptic women and in a control group of normal (NORM) pregnancies in the postpartum. METHODS Sixty-three consecutive preeclamptic women (age 35 ± 6 years) were studied 4 weeks after delivery. We collected clinical and lab information on pregnancy and neonates and measured plasma and urinary calcium and phosphate, plasma parathyroid hormone (PTH) and 25-hydroxy vitamin D [25(OH)D], and performed 24-h ambulatory BP monitoring. BP and calcium metabolism of 51 preeclamptic were compared with 17 NORM pregnant women that matched for age, race, and postpartum BMI. RESULTS 25(OH)D deficiency (<10 ng/ml) was found in 3% of preeclamptic women, insufficiency (10-30 ng/ml) in 67%, and NORM values (31-100 ng/ml) in the remaining 30%. Elevated plasma PTH (≥79 pg/ml) was found in 24% of preeclamptic women who had 25(OH)D plasma levels of 21.4 ± 8.3 ng/ml. In these women, PTH levels was independently associated with 24-h SBP and DBP and daytime and night-time DBP. Prevalence of nondippers and reverse dippers was elevated (75% and 33%, respectively). No associations between calcium metabolism and neonates' characteristics of preeclamptic women were observed. Prevalence of vitamin D deficiency and insufficiency and of elevated plasma PTH levels were comparable in matched groups. Considering preeclamptic women and matched controls as a whole group, office SBP and DBP levels were associated with PTH independently of preeclampsia and other confounders. CONCLUSION Features of secondary hyperparathyroidism are common in the postpartum. Preeclampsia and increased PTH levels were both independent factors associated with increased BP after delivery, and both might affect the future cardiovascular risk of these women.
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16
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Wright C, King D, Small M, Gibson C, Gardner R, Stack BC. The Utility of the Cl:PO4 Ratio in Patients With Variant Versions of Primary Hyperparathyroidism. Otolaryngol Head Neck Surg 2020; 164:308-314. [PMID: 32746759 DOI: 10.1177/0194599820947009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the significance and impact of additional chloride testing as part of a diagnostic laboratory test battery for borderline primary hyperparathyroidism (pHPT). STUDY DESIGN Retrospective database review of parathyroidectomy patients. SETTING A tertiary care, academic health sciences center. SUBJECTS AND METHODS Patients referred to a head and neck endocrine clinic for evaluation and treatment for pHPT. RESULTS After exclusions, there were a total of 226 patients who underwent parathyroidectomy for primary hyperparathyroidism with the requisite preoperative and postoperative labs. Seventy-seven additional patients who had a thyroid operation for a nonmalignant cause were included as controls. Of the 303 total patients, 166 had normal calcium levels (<10.4 mg/dL), and 54 (32.5%) also exhibited hyperchloremia (>106 mmol/L). Of the 47 patients with normal calcium and parathyroid hormone (PTH) levels (<88 pg/mL), 6 (12.8%) had hyperchloremia, and of the 118 patients with normocalcemic pHPT, 48 (40.7%) were hyperchloremic. The area under the curve for the Cl:PO4 was 0.712. When using a cutoff of 33, the reported sensitivity and specificity of the curve were 58.4% and 28.6%, respectively. CONCLUSION The Cl:PO4 ratio was a moderately sensitive test for the diagnosis of the borderline variants of primary hyperparathyroidism. The Ca:PO4 ratio was superior to the Cl:PO4 ratio. Our data also showed the superiority of preoperative calcium and ionized calcium over PTH when predicting the presence of pHPT.
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Affiliation(s)
- Courtney Wright
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mariah Small
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Celeste Gibson
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Sothern Illinois University School of Medicine, Springfield, Illinois, USA
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17
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Aengevaeren VL, Mosterd A, Sharma S, Prakken NHJ, Möhlenkamp S, Thompson PD, Velthuis BK, Eijsvogels TMH. Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management. Circulation 2020; 141:1338-1350. [PMID: 32310695 PMCID: PMC7176353 DOI: 10.1161/circulationaha.119.044467] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques. This review describes the effects of physical activity and exercise training on coronary atherosclerosis in athletes who are middle-aged and older and aims to contribute to the understanding of the potential adverse effects of the highest doses of exercise training on the coronary arteries. For this purpose, we will review the association between exercise and coronary atherosclerosis measured using computed tomography, discuss the potential underlying mechanisms for exercise-induced coronary atherosclerosis, determine the clinical relevance of coronary atherosclerosis in middle-aged athletes and describe strategies for the clinical management of athletes with coronary atherosclerosis to guide physicians in clinical decision making and treatment of athletes with elevated coronary artery calcification scores.
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Affiliation(s)
- Vincent L Aengevaeren
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands (A.M.)
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom (S.S.)
| | - Niek H J Prakken
- Department of Radiology, University Medical Center Groningen, The Netherlands (N.H.J.P.)
| | - Stefan Möhlenkamp
- Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Germany (S.M.)
| | | | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands (B.K.V.)
| | - Thijs M H Eijsvogels
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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18
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Dai L, Debowska M, Lukaszuk T, Bobrowski L, Barany P, Söderberg M, Thiagarajan D, Frostegård J, Wennberg L, Lindholm B, Qureshi AR, Waniewski J, Stenvinkel P. Phenotypic features of vascular calcification in chronic kidney disease. J Intern Med 2020; 287:422-434. [PMID: 31823455 DOI: 10.1111/joim.13012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with chronic kidney disease stage 5 (CKD5) are predisposed to vascular calcification (VC), but the combined effect of factors associated with VC was sparsely investigated. We applied the relaxed linear separability (RLS) feature selection model to identify features that concomitantly associate with VC in CKD5 patients. METHODS Epigastric arteries collected during surgery from living donor kidney transplant recipients were examined to score the histological extent of medial VC. Sixty-two phenotypic features in 152 patients were entered into RLS model to differentiate between no-minimal VC (n = 93; score 0-1) and moderate-extensive VC (n = 59; score 2-3). The subset of features associated with VC was selected on the basis of cross-validation procedure. The strength of association of the selected features with VC was expressed by the absolute value of 'RLS factor'. RESULTS Among 62 features, a subset of 17 features provided optimal prediction of VC with 89% of patients correctly classified into their groups. The 17 features included traditional risk factors (diabetes, age, cholesterol, BMI and male sex) and markers of bone metabolism, endothelial function, metabolites, serum antibodies and mitochondrial-derived peptide. Positive RLS factors range from 1.26 to 4.05 indicating features associated with increased risk of VC, and negative RLS factors range from -0.95 to -1.83 indicating features associated with reduced risk of VC. CONCLUSION The RLS model identified 17 features including novel biomarkers and traditional risk factors that together concomitantly associated with medial VC. These results may inform further investigations of factors promoting VC in CKD5 patients.
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Affiliation(s)
- L Dai
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - M Debowska
- Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - T Lukaszuk
- Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - L Bobrowski
- Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.,Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - P Barany
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - M Söderberg
- Pathology, Clinical Pharmacology and Safety Sciences, AstraZeneca R&D, Gothenburg, Sweden
| | - D Thiagarajan
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L Wennberg
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - B Lindholm
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - A R Qureshi
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J Waniewski
- Department for Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - P Stenvinkel
- From the, Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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19
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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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20
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Coronary artery calcification: recent developments in our understanding of its pathologic and clinical significance. Curr Opin Cardiol 2019; 33:645-652. [PMID: 30307412 DOI: 10.1097/hco.0000000000000558] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Prior investigations have shown the close association between coronary artery calcification (CAC) and total atherosclerotic plaque burden as well as the risk of cardiovascular and all-cause mortality. However, recent pathologic and imaging-based studies suggested that massive dense calcifications are usually associated with stable plaque; whereas, micro calcifications, especially in the thin fibrous cap, are related to vulnerable characteristics. Further, the molecular mechanisms for initiation/progression of vascular calcification are highly complex and still need to be elucidated. In this manuscript, we discuss recent advancement in our understanding of CAC from the basic, pathologic, and clinical perspectives. RECENT FINDINGS Research on the relationship between genetic polymorphisms and CAC has been growing and may potentially lead to future precision-based medicine. In basic research field, more attention has been focused on the relationship between inflammation and vascular calcification. Large-scale imaging based studies support the association between statin and calcification progression, maybe one of the ways by which statins prevent cardiovascular events. Nevertheless, the mechanism responsible for this effect is still not fully understood. Optical coherence tomography has improved resolution to detect CAC over traditional CT and may be especially promising for the detection of calcified nodules. SUMMARY A better understanding of CAC in all of its forms will advance our understanding of its natural history of atherosclerosis. More work is needed to understand the basic molecular mechanisms responsible for the initiation/progression of CAC, which may eventually lead to the development of effective treatments for atherosclerosis.
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21
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Lam HB, Yang PS, Chien MN, Lee JJ, Chao LF, Cheng SP. Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism. Arch Med Sci 2019; 15:880-886. [PMID: 31360183 PMCID: PMC6657247 DOI: 10.5114/aoms.2018.74758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/11/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is associated with adverse cardiovascular outcomes which may result from an increase in systemic inflammation. Previously we have shown that serum parathyroid hormone (PTH) levels are independently associated with inflammatory indicators. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, widely available marker of inflammation. In the present study, we aimed to assess the longitudinal changes in NLR before and after parathyroidectomy. MATERIAL AND METHODS This retrospective study included 95 patients diagnosed with PHPT who underwent parathyroidectomy between 2006 and 2016. Follow-up complete blood counts were available in 31 patients. RESULTS At diagnosis, 43 (45%) patients presented with overt clinical symptoms and had higher serum calcium and PTH levels. Preoperative NLR was positively correlated with total white blood cell count (p = 0.001), serum calcium (p = 0.001), and PTH level (p = 0.013). The NLR was not associated with sex, age, comorbidities, or parathyroid weight. Among patients who were cured of PHPT, the median NLR decreased from 2.26 to 1.77 after parathyroidectomy (p = 0.037). There was no difference in hemoglobin, total white blood cells, or platelet count before and after surgery. CONCLUSIONS We found a positive correlation of preoperative NLR with calcium and PTH levels in PHPT patients. After curative parathyroidectomy, NLR modestly decreased without changes in other hematological parameters.
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Affiliation(s)
- Hung-Bun Lam
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Po-Sheng Yang
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Ming-Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan
| | - Li-Fen Chao
- Department of Nursing, Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan
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22
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Billington EO, Murphy R, Gamble GD, Callon K, Davies N, Plank LD, Booth M, Reid IR. Fibroblast growth factor 23 levels decline following sleeve gastrectomy. Clin Endocrinol (Oxf) 2019; 91:87-93. [PMID: 30943313 DOI: 10.1111/cen.13981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Levels of fibroblast growth factor 23 (FGF23) have been positively associated with measures of adiposity, cardiovascular disease and mortality. It is unclear whether the relationship of FGF23 with cardiovascular disease and mortality is confounded by obesity. We aimed to determine whether FGF23 concentrations decline following a reduction in adiposity after sleeve gastrectomy (SG). DESIGN The effect of SG on FGF23 was evaluated in 22 obese adults (59% male) with type 2 diabetes. Fat mass, weight, BMI, plasma intact FGF23, parathyroid hormone (PTH) and leptin were determined at baseline and at 12 months following SG. RESULTS At baseline, median (IQR) age was 51 (43-54) years, fat mass 47.8 (41.0-59.4) kg, BMI 40.9 (36.9-46.9) kg/m2 and FGF23 66.2 (55.3-82.9) pg/mL. Significant changes in median BMI (-10.8 kg/m2 , 95% CI: -12.9 to -7.2, P < 0.0001), fat mass (-20.0 kg, 95% CI: -26.7 to -12.4, P < 0.0001) and weight (-34.7 kg, 95% CI -40.0 to -23.1, P < 0.0001) were observed after SG. FGF23 (-12.4 pg/mL, 95% CI: -19.5 to 2.0, P = 0.005), PTH (-1.1 pmol/L, 95% CI: -1.7 to 0.2, P = 0.009) and leptin (-1687 pg/mL, 95% CI -4524 to -563, P = 0.01) declined following SG. Change in FGF23 was not significantly associated with change in measures of adiposity, PTH or leptin. CONCLUSIONS FGF23 concentrations decline in the setting of significant weight loss following SG, implying that increased FGF23 concentrations are a downstream consequence of obesity, which may confound its association with cardiometabolic dysfunction. Mediators of the relationship between adiposity and FGF23 require further elucidation.
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Affiliation(s)
- Emma O Billington
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
- Cumming School of Medicine, Division of Endocrinology & Metabolism, University of Calgary, Calgary, Alberta, Canada
| | - Rinki Murphy
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen Callon
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Naomi Davies
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lindsay D Plank
- Faculty of Medical and Health Sciences, Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Michael Booth
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Ian R Reid
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
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Beysel S, Caliskan M, Kizilgul M, Apaydin M, Kan S, Ozbek M, Cakal E. Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism. BMC Cardiovasc Disord 2019; 19:106. [PMID: 31068134 PMCID: PMC6505186 DOI: 10.1186/s12872-019-1093-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/30/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Parathyroidectomy has ameliorated cardiovascular risk factors in patients with hypercalcemic primary hyperparathyroidism (PHPT), but the effect of parathyroidectomy on normocalcemic PHPT is not exactly known. This case-controlled study aimed to investigate the effect of parathyroidectomy on cardiovascular risk factors in patients with normocalcemic and hypercalcemic PHPT. METHODS Subjects with normocalcemic PHPT (n = 35), age- and sex-matched hypercalcemic PHPT (n = 60) and age- and sex-matched control (n = 60) were included. Cardiometabolic disorders were investigated with traditional cardiometabolic risk factors and the Framingham cardiovascular risk score (CRS) before and 6 months after parathyroidectomy. RESULTS Diabetes, dyslipidemia, hypertension, obesity, insulin resistance, osteoporosis, having fractures were similarly increased in the hypercalcemic and normocalcemic PHPT groups (p > 0.05) compared with the controls (p < 0.05). Blood pressures, glucose metabolism (glucose, insulin, HOMA-IR) and lipid profiles were similarly increased in the PHPT groups (p > 0.05) compared with the controls (p < 0.05). After parathyroidectomy, blood pressures, serum total cholesterol, and HOMA-IR were decreased in both PHPT groups (p < 0.05). CRS was lower in the controls (5.74 ± 3.24, p < 0.05). After parathyroidectomy, CRS was decreased in the normocalcemic (11.98 ± 10.11 vs. 7.37 ± 4.48) and hypercalcemic (14.62 ± 11.06 vs. 8.05 ± 7.72) PHPT groups. Increased blood pressures were independent predictors of serum iPTH. CONCLUSION The normocalcemic and hypercalcemic PHPT groups had similarly increased cardiovascular risk factors, even independently of serum calcium. Parathyroidectomy ameliorated the increased cardiovascular risk factors in both normocalcemic and hypercalcemic PHPT.
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Affiliation(s)
- Selvihan Beysel
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
- Department of Medical Biology, Baskent University, Ankara, Turkey
- Department of Endocrinology and Metabolism, Afyonkarahisar Saglik Bilimleri University, Afyonkarahisar, Turkey
| | - Mustafa Caliskan
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Mahmut Apaydin
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Seyfullah Kan
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
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Chang YC, Hsu BG, Liou HH, Lee CJ, Wang JH. Serum levels of sclerostin as a potential biomarker in central arterial stiffness among hypertensive patients. BMC Cardiovasc Disord 2018; 18:214. [PMID: 30482161 PMCID: PMC6260557 DOI: 10.1186/s12872-018-0955-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sclerostin is known to be a canonical Wnt/β-catenin signaling pathway inhibitor, while the Wnt/β-catenin signaling pathway is proposed to be involved in the development of arterial stiffness. This study aims to investigate the relationship between serum sclerostin levels and carotid-femoral pulse wave velocity (cfPWV) among hypertensive patients. METHODS Fasting blood samples were obtained from 105 hypertensive patients. Patients with cfPWV values of > 10 m/s were classified in the high arterial stiffness group, whereas those with cfPWV values of ≤10 m/s were assigned to the low arterial stiffness group. Serum sclerostin and Dickkopf-1 (DKK1) levels were quantified using commercially available enzyme-linked immunosorbent assays. RESULTS Thirty-six hypertensive patients (34.3%) who belonged to the high arterial stiffness group were generally older (p < 0.001), presented with lower estimated glomerular filtration rates (eGFR, p = 0.014), higher incidence of diabetes mellitus (p = 0.030), average systolic blood pressures (SBP, p = 0.013), pulse pressure (p = 0.026), serum creatinine levels (p = 0.013), intact parathyroid hormone levels (iPTH, p = 0.003), and sclerostin levels (p < 0.001) than their counterparts in the low arterial stiffness group. A multivariable logistic regression analysis identified sclerostin as an independent predictor of arterial stiffness in hypertensive patients (odds ratio, 1.042; 95% confidence interval (CI), 1.017-1.068; p = 0.001). Multivariable forward stepwise linear regression analysis also showed that serum sclerostin level (β = 0.255, adjusted R2 change: 0.146, p = 0.003) was positively associated with cfPWV values in patients with hypertension. CONCLUSIONS In this study, serum sclerostin level, but not DKK1, is found to be positively correlated with cfPWV values and is identified as an independent predictor of arterial stiffness in hypertensive patients after adjusting for significant confounders.
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Affiliation(s)
- Yu-Chi Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Cardiology, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung-Yang Road, Hualien, 97004 Taiwan
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Ling Y, Wang Z, Wu B, Gao X. Association of bone metabolism markers with coronary atherosclerosis and coronary artery disease in postmenopausal women. J Bone Miner Metab 2018. [PMID: 28642975 DOI: 10.1007/s00774-017-0841-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study aimed to evaluate the association of bone metabolism markers with coronary atherosclerosis and coronary artery disease (CAD) in postmenopausal women. Based on the findings of coronary angiography, 111 women with CAD and 116 women without CAD were recruited. Serum calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, N-terminal propeptide of type I procollagen (P1NP) and C-terminal cross-linked telopeptide of type I collagen (CTX) were measured. The Gensini score was used to assess the severity of coronary atherosclerosis. Compared with women with serum calcium ≤2.29 mmol/L, women with serum calcium >2.29 mmol/L had a 2.63-fold increased risk of CAD after adjusting for multiple cardiovascular risks, PTH and 25OHD [odds ratio (OR) = 2.91, 95% confidence interval (CI) 1.35-6.28]. In the fully adjusted model plus PTH and 25OHD, the risk of CAD increased 1.87-fold with every 1-SD increment of serum calcium (OR = 1.87, 95% CI 1.21-2.88). To further analyze the potential strong confounding effect of albumin, the absolute levels of calcium were replaced by their albumin-corrected values in the regression model. Compared with women with albumin-corrected calcium ≤2.27 mmol/L, women with albumin-corrected calcium >2.27 mmol/L had a 2.36-fold increased risk of CAD in the fully adjusted model plus PTH and 25OHD (OR = 2.36, 95% CI 1.13-4.92). The risk of coronary atherosclerosis as defined by Gensini score >0 increased 1.73-fold with every 1-SD increment of serum calcium in the fully adjusted model plus PTH and 25OHD (OR = 1.73, 95% CI 1.09-2.73). However, albumin-corrected calcium was not associated with coronary atherosclerosis either as a categorical variable or as a continuous variable in all models. No significant association of PTH, 25OHD, osteocalcin, CTX and P1NP with CAD or coronary atherosclerosis was found in this study. Higher serum calcium levels were independently associated with CAD in postmenopausal women.
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Affiliation(s)
- Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Zhen Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Bingjie Wu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University and Institute of Chronic Metabolic Diseases of Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
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Fujii H. Association between Parathyroid Hormone and Cardiovascular Disease. Ther Apher Dial 2018; 22:236-241. [PMID: 29707916 DOI: 10.1111/1744-9987.12679] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/21/2018] [Accepted: 02/02/2018] [Indexed: 12/01/2022]
Abstract
Although parathyroid hormone is known to be related with calcium and phosphate metabolism, it has been also reported to have several effects on the cardiovascular system including heart and vessels. However, the detailed pathophysiological mechanisms remain unclear. Clinical studies have indicated that parathyroid hormone is associated with cardiovascular events and mortality not only in patients with chronic kidney disease but also in those without chronic kidney disease. As a possible mechanism, it is thought that parathyroid hormone is associated with the renin-angiotensin-aldosterone system and has direct effects on the cardiovascular system. Therefore, we should pay attention to not only the control of serum phosphate and calcium levels but also the control of serum parathyroid hormone levels, especially in patients with chronic kidney disease.
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Affiliation(s)
- Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
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Independent effects of blood pressure and parathyroid hormone on aortic pulse wave velocity in untreated Chinese patients. J Hypertens 2018; 35:1841-1848. [PMID: 28445206 DOI: 10.1097/hjh.0000000000001395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Whether or not calcium-regulating hormones stiffen arteries independent of blood pressure (BP) is uncertain. We investigated the independent associations of carotid-femoral pulse wave velocity (PWV) with 25-hydroxy-vitamin D [25(OH)D], parathyroid hormone (PTH) and 24-h ambulatory BP in untreated Chinese patients. METHODS Consecutive untreated patients referred for ambulatory BP monitoring were recruited. PWV was measured with a high-fidelity micromanometer and the SphygmoCor software (AtCor Medical, West Ryde, New South Wales, Australia). Serum 25(OH)D and PTH were determined by electrochemiluminescence immunoassay. Analysis of variance, single and multiple regressions were applied for analyses. RESULTS In 1052 untreated patients (50.7% women; mean age, 51 years), PWV averaged 7.8 m/s, 24-h SBP/DBP 126.5/81.7 mmHg, serum 25(OH)D and PTH 36.0 nmol/l and 61.6 pg/ml, respectively. In multivariable-adjusted analyses, BP (P < 0.001) and PTH (P = 0.012) increased from less than 25th to at least 75th percentile of the PWV distribution. In continuous analyses, PWV independently increased by 0.40/0.23 m/s per 1-SD increment in SBP/DBP (P < 0.001) and by 0.14 m/s for a doubling of serum PTH (P = 0.029). Associations of PWV with BP were tighter than with PTH (P < 0.001). In pathway analysis, the effect of PTH on PWV did not run via serum or urinary calcium (P = 0.65), but PTH had both a direct (P = 0.026) and a BP-mediated indirect effect (P = 0.043) on PWV. In none of our analyses were PWV associated with serum 25(OH)D. CONCLUSION Arterial stiffness, as assessed by PWV, independently increased both with BP and with PTH, but BP remains the main driver of arterial stiffening.
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Cheng YB, Guo QH, Zhang DY, Wang Y, Huang QF, Sheng CS, Wang JG, Staessen JA, Li Y. Association of pulse wave velocity with single nucleotide polymorphisms related to parathyroid hormone. Blood Press 2018; 27:222-230. [PMID: 29504807 DOI: 10.1080/08037051.2018.1445961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Carotid-femoral pulse wave velocity (cfPWV) was associated with serum parathyroid hormone (PTH) in untreated Chinese. We investigated in the same cohort whether cfPWV, brachial-ankle (baPWV) and heart-brachial (hbPWV) pulse wave velocity (PWV) were associated with rs6127099 (CYP24A1) and rs4074995 (RGS14). A previously published genome-wide association study demonstrated that each additional copy of the T (rs6127099) or G (rs4074995) allele was associated with a 7% or 3% higher serum PTH, respectively. METHODS In 1601 untreated Chinese patients (mean age, 51.0 years; 51.9% women), we measured cfPWV by tonometry (SphygmoCor) and baPWV and hbPWV by combined oscillometry and plethysmography (VP-2000 PWV/ABI analyser), serum PTH by an immunoassay, and genotypes by the SNapShot method. RESULTS cfPWV, baPWV and hbPWV averaged 7.9, 14.6 and 5.5 m/s and serum PTH 65.7 pg/mL. Genotype frequencies were in Hardy-Weinberg equilibrium, amounting to 41.7% (AA), 44.9% (AT) and 13.4% (TT) for rs6127099 and to 70.7% (GG), 26.9% (GA) and 2.3% (AA) for rs4074995. With adjustments applied for sex, age, body mass index, heart rate and season, hbPWV was 0.05 m/s (p = .042) lower with each additional copy of the minor allele (T) of rs6127099. In similarly adjusted analyses of 157 normotensive participants younger than 50 years, cfPWV was 0.32 m/s (p = .004) higher per additional copy of the T allele. Sensitivity analyses additionally accounting for the total-to-HDL serum cholesterol ratio, plasma glucose, glomerular filtration rate and 24 h systolic blood pressure were consistent. No other association of PWV with the genetic variants reached significance. CONCLUSIONS With an increasing number of rs6127099 T alleles, arterial stiffness, as exemplified by PWV, was lower in all participants in a muscular artery (hbPWV), but higher in young normotensive participants in an elastic artery (cfPWV).
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Affiliation(s)
- Yi-Bang Cheng
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Qian-Hui Guo
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Dong-Yan Zhang
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Ying Wang
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Qi-Fang Huang
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Chang-Sheng Sheng
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Ji-Guang Wang
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Jan A Staessen
- b Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,c Cardiovascular Research Institute Maastricht (CARIM) , Maastricht University , Maastricht , The Netherlands
| | - Yan Li
- a Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations , Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
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Pepe J, Cipriani C, Sonato C, Raimo O, Biamonte F, Minisola S. Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur J Endocrinol 2017; 177:R297-R308. [PMID: 28864535 DOI: 10.1530/eje-17-0485] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 01/02/2023]
Abstract
Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.
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Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Chiara Sonato
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Orlando Raimo
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Federica Biamonte
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
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Morsy MS, Dishmon DA, Garg N, Weber KT. Secondary Hyperparathyroidism in Heart Failure. Am J Med Sci 2017; 354:335-338. [DOI: 10.1016/j.amjms.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/07/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022]
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31
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Braber TL, Reitsma JB, Mosterd A, Willemink MJ, Prakken NHJ, Halle M, Sharma S, Velthuis BK. Cardiac imaging to detect coronary artery disease in athletes aged 35 years and older. A scoping review. Scand J Med Sci Sports 2017; 28:1036-1047. [DOI: 10.1111/sms.12974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Affiliation(s)
- T. L. Braber
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Cardiology; Meander Medical Center; Amersfoort The Netherlands
| | - J. B. Reitsma
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Mosterd
- Department of Cardiology; Meander Medical Center; Amersfoort The Netherlands
| | - M. J. Willemink
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - N. H. J. Prakken
- Department of Radiology; University Medical Center Groningen; Groningen The Netherlands
| | - M. Halle
- German Heart Center; Technical University Hospital; Munich Germany
| | - S. Sharma
- Department of Cardiovascular Sciences; St George's University of London; London UK
| | - B. K. Velthuis
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
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Gleason PT, Kim JH. Exercise and Competitive Sport: Physiology, Adaptations, and Uncertain Long-Term Risks. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:79. [PMID: 28913725 DOI: 10.1007/s11936-017-0578-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT The benefits of regular and moderate exercise training on cardiovascular outcomes have been well established. In addition, strenuous exercise training leads to corollary cardiac structural and functional adaptations that are sport-specific and facilitate athletic performance. In this review, the normal physiologic and hemodynamic changes that occur during exercise and the subsequent differential exercise-induced cardiac remodeling patterns that develop will be discussed. Paradoxically, recent data have raised concern about the long-term impact of higher doses of physical activity and exercise on mortality and cardiovascular health outcomes. We will discuss important aspects of these controversial data and review the supporting evidence as well as the limitations of prior research. Specifically, we will address the association between high levels of exercise and relative reductions in overall mortality, increased risk of atrial fibrillation, arrhythmogenic cardiac remodeling, and accelerated coronary artery calcifications. For the practitioner, this review aims to detail these contemporary sports cardiology controversies and highlights the critical need to incorporate shared decision making with the athlete in dealing with the uncertainties that exist. Finally, we will discuss key "athlete-specific" variables that should be considered in the design of future important research in this arena.
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Affiliation(s)
- Patrick T Gleason
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road, NE, Suite 502, Atlanta, GA, 30322, USA
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road, NE, Suite 502, Atlanta, GA, 30322, USA.
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Sedky NK, Hassanein SI, Gad MZ. Independent assortment of GC gene polymorphism (rs2282679) and 25-hydroxyvitamin D levels in coronary artery disease. Can J Physiol Pharmacol 2017; 96:345-351. [PMID: 28892641 DOI: 10.1139/cjpp-2017-0334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Coronary artery disease (CAD) remains a major public health burden. Emerging research has suggested an association between vitamin D insufficiency and CAD. Vitamin D binding protein (VDBP) is the primary vitamin D carrier and many of its genetic polymorphisms are able to induce the expression of proteins with different affinities for the vitamin, which in turn might affect its serum levels and CAD incidence. One hundred and twelve male patients, aged between 35 and 50 years, with verified CAD and 109 age- and sex-matched controls were recruited. Genotyping was performed by the TaqMan allelic discrimination assay and plasma 25(OH)D levels were assessed by HPLC-UV. Serum parathyroid hormone (s-PTH) and VDBP levels were measured using ELISA. s-25(OH)D levels in CAD patients were significantly lower than in the controls, whereas s-PTH levels were significantly higher in the CAD patients than in the controls. There was no significant difference in the distribution of GC genotypes among both groups. s-25(OH)D showed a weak inverse correlation with s-PTH levels. Serum levels of vitamin D and PTH are highly correlated with CAD incidence. However, the s-VDBP level is associated neither with disease outcome nor with vitamin D status. The GC gene variant has no effect on 25(OH)D levels.
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Affiliation(s)
- Nada K Sedky
- a Biomedical Sciences Program, Zewail City of Science and Technology, Giza, 12566, Egypt
| | - Sally I Hassanein
- b Clinical Biochemistry Unit, Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, New Cairo City, 11835, Egypt
| | - Mohamed Zakaria Gad
- b Clinical Biochemistry Unit, Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, New Cairo City, 11835, Egypt
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Chen MC, Hsu BG, Lee CJ, Yang CF, Wang JH. High serum adipocyte fatty acid binding protein level as a potential biomarker of aortic arterial stiffness in hypertensive patients with metabolic syndrome. Clin Chim Acta 2017; 473:166-172. [PMID: 28860092 DOI: 10.1016/j.cca.2017.08.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/02/2017] [Accepted: 08/27/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The adipocyte-fatty-acid-binding protein (A-FABP) has been implicated in arterial stiffness, metabolic syndrome (MetS), and cardiovascular disease. We aimed to determine the relationship among serum A-FABP concentration, cardiometabolic risk factors, and central arterial stiffness in a hypertensive population. METHODS Fasting blood samples and baseline characteristics were obtained from 110 hypertensive patients. Serum A-FABP concentrations were determined by enzyme immunoassay kit. High arterial stiffness was defined as carotid-femoral pulse wave velocity values >10m/s via the SphygmoCor system. RESULTS Patients with MetS and high arterial stiffness accounted for 67.3% and 42.7% of the study population, respectively. Serum A-FABP was positively associated with MetS and high arterial stiffness (P=0.006 and P<0.001, respectively). Multivariable stepwise linear regression analysis of the significant variables of arterial stiffness revealed that logarithmically transformed A-FABP (log-A-FABP, β=0.278, P=0.002) was positively correlated arterial stiffness in hypertensive patients. Subgroup analysis revealed that log-A-FABP (β=0.327, P=0.003), age (β=0229, P=0.032), and triglyceride (β=0.307, P=0.004) were significantly positively correlated with arterial stiffness in hypertensive patients with MetS. CONCLUSIONS Elevated A-FABP concentration could be a predictor for MetS and arterial stiffness in hypertensive patients.
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Affiliation(s)
- Ming-Chun Chen
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Chiu-Fen Yang
- Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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Aengevaeren VL, Mosterd A, Braber TL, Prakken NHJ, Doevendans PA, Grobbee DE, Thompson PD, Eijsvogels TMH, Velthuis BK. Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes. Circulation 2017; 136:138-148. [PMID: 28450347 DOI: 10.1161/circulationaha.117.027834] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Higher levels of physical activity are associated with a lower risk of cardiovascular events. Nevertheless, there is debate on the dose-response relationship of exercise and cardiovascular disease outcomes and whether high volumes of exercise may accelerate coronary atherosclerosis. We aimed to determine the relationship between lifelong exercise volumes and coronary atherosclerosis. METHODS Middle-aged men engaged in competitive or recreational leisure sports underwent a noncontrast and contrast-enhanced computed tomography scan to assess coronary artery calcification (CAC) and plaque characteristics. Participants reported lifelong exercise history patterns. Exercise volumes were multiplied by metabolic equivalent of task (MET) scores to calculate MET-minutes per week. Participants' activity was categorized as <1000, 1000 to 2000, or >2000 MET-min/wk. RESULTS A total of 284 men (age, 55±7 years) were included. CAC was present in 150 of 284 participants (53%) with a median CAC score of 35.8 (interquartile range, 9.3-145.8). Athletes with a lifelong exercise volume >2000 MET-min/wk (n=75) had a significantly higher CAC score (9.4 [interquartile range, 0-60.9] versus 0 [interquartile range, 0-43.5]; P=0.02) and prevalence of CAC (68%; adjusted odds ratio [ORadjusted]=3.2; 95% confidence interval [CI], 1.6-6.6) and plaque (77%; ORadjusted=3.3; 95% CI, 1.6-7.1) compared with <1000 MET-min/wk (n=88; 43% and 56%, respectively). Very vigorous intensity exercise (≥9 MET) was associated with CAC (ORadjusted=1.47; 95% CI, 1.14-1.91) and plaque (ORadjusted=1.56; 95% CI, 1.17-2.08). Among participants with CAC>0, there was no difference in CAC score (P=0.20), area (P=0.21), density (P=0.25), and regions of interest (P=0.20) across exercise volume groups. Among participants with plaque, the most active group (>2000 MET-min/wk) had a lower prevalence of mixed plaques (48% versus 69%; ORadjusted=0.35; 95% CI, 0.15-0.85) and more often had only calcified plaques (38% versus 16%; ORadjusted=3.57; 95% CI, 1.28-9.97) compared with the least active group (<1000 MET-min/wk). CONCLUSIONS Participants in the >2000 MET-min/wk group had a higher prevalence of CAC and atherosclerotic plaques. The most active group, however, had a more benign composition of plaques, with fewer mixed plaques and more often only calcified plaques. These observations may explain the increased longevity typical of endurance athletes despite the presence of more coronary atherosclerotic plaque in the most active participants.
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Affiliation(s)
- Vincent L Aengevaeren
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.).
| | - Arend Mosterd
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Thijs L Braber
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Niek H J Prakken
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Pieter A Doevendans
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Diederick E Grobbee
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Paul D Thompson
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Thijs M H Eijsvogels
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.).
| | - Birgitta K Velthuis
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
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Lind L. Comment on JIM-16-0640.R1. 'Mortality from aortic stenosis - prospective study of serum calcium and phosphate' by D. Wald. J Intern Med 2017; 281:412-413. [PMID: 28229496 DOI: 10.1111/joim.12597] [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: 11/30/2022]
Affiliation(s)
- L Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
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Verdoia M, Pergolini P, Rolla R, Nardin M, Barbieri L, Schaffer A, Bellomo G, Marino P, Suryapranata H, De Luca G. Parathyroid Hormone Levels and High-Residual Platelet Reactivity in Patients Receiving Dual Antiplatelet Therapy With Acetylsalicylic Acid and Clopidogrel or Ticagrelor. Cardiovasc Ther 2017; 34:209-15. [PMID: 27086085 DOI: 10.1111/1755-5922.12188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-residual-on-treatment platelet reactivity still represents a challenging issue, potentially vanishing the benefits of dual antiplatelet treatment in patients with coronary artery disease. However, very few is known on the determinants of suboptimal response to antiplatelet agents. Recent interests have emerged on the potential prothrombotic effect of parathyroid hormone (PTH). Therefore, the aim of the present study was to assess the impact of parathyroid hormone (PTH) on platelet reactivity in patients receiving DAPT after an acute coronary syndrome or PCI. METHODS Patients treated with DAPT (ASA and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30- to 90-days postdischarge. By whole blood impedance aggregometry, HRPR was considered for ASPI test >862 AU*min (for ASA) and ADP test values ≥417 AU*min (for ADP antagonists). RESULTS We included 362 patients on DAPT, 125 (34.5%) receiving clopidogrel, and 237 (65.5%) on ticagrelor. Patients were divided according to PTH quartiles values (<45.8; 45.8-60.3; 60.4-88; ≥88.1 pg/mL). Higher PTH was associated with older age (P = 0.001); renal failure (P < 0.001), higher HDL cholesterol (P = 0.006) and creatinine (P < 0.001) and lower 25-OH cholecalciferol (P < 0.001). Suboptimal response to ASA was infrequent (2.8%), and not influenced by the levels of PTH (P = 0.57). ADP-mediated platelet aggregation was significantly increased in patients with higher PTH (P = 0.03), with an absolute increase in the prevalence of HRPR to ADP antagonists for higher PTH (24.7% vs. 40%, P = 0.007 for 4th vs. 1-3rd quartiles, adjusted OR[95%CI] = 2.04[1.14-3.64], P = 0.02). By the use of the ROC curve, we identified PTH levels above 96.7 pg/mL as the best predictor of HRPR with ADP antagonists (adjusted OR[95%CI] = 2.52[1.31-4.87], P = 0.006). Higher rate of HRPR was confirmed for PTH >96.7 pg/mL among the subgroup of patients on clopidogrel (51.5 vs. 85.7%, P = 0.001; adjusted OR[95%CI] = 12.5[2.6-60.9], P = 0.002), but not among ticagrelor-treated patients (11.3 vs. 16.7%, P = 0.31; adjusted OR[95%CI] = 1.55[0.56-4.6], P = 0.42). CONCLUSION In patients receiving dual antiplatelet therapy for coronary artery disease, higher PTH levels are associated with an increased ADP-mediated platelet reactivity and suboptimal response to clopidogrel, especially for values above 96.7 pg/mL, while not influencing the effectiveness of ASA and ticagrelor.
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Affiliation(s)
- Monica Verdoia
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Patrizia Pergolini
- Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Roberta Rolla
- Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Matteo Nardin
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Lucia Barbieri
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Alon Schaffer
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Giorgio Bellomo
- Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Paolo Marino
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | | | - Giuseppe De Luca
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
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Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk. DISEASE MARKERS 2017; 2017:4343171. [PMID: 28115793 PMCID: PMC5237770 DOI: 10.1155/2017/4343171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
Abstract
Objective. It was examined whether PTH and 25-dihydroxyvitamin D (25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH)D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH)D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH)D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH)D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully.
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Parathyroid hormone reflects adiposity and cardiometabolic indices but not bone density in normal men. BONEKEY REPORTS 2016; 5:852. [PMID: 28018585 DOI: 10.1038/bonekey.2016.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/02/2016] [Indexed: 12/12/2022]
Abstract
Hyperparathyroidism may be associated with skeletal and cardiovascular abnormalities, but it is unclear whether these associations exist for high-normal levels of parathyroid hormone (PTH). We assessed relationships between PTH and anthropometric, skeletal and cardiometabolic indices in normal men. Body composition, blood pressure, biochemistry and bone mineral density (BMD) were evaluated in 151 healthy men. BMD was reassessed at 2 years, and coronary artery calcium (CAC) was measured at 3.5 years. Relationships between PTH and other baseline characteristics, CAC scores and change in BMD were evaluated. PTH correlated positively with baseline body mass index, fat mass, diastolic blood pressure, triglycerides, total and low-density lipoprotein (LDL) cholesterol, (r=0.19-0.25, P=0.02-0.002), and with category of CAC score. Relationships between PTH and cardiometabolic indices remained significant after adjustment for age, 25-hydroxyvitamin D and estimated glomerular filteration rate. Men in the top PTH tertile (⩾4.4 pmol l-1, n=51) were more likely to have LDL cholesterol ⩾3.5 mmol l-1, diastolic blood pressure ⩾85 mm Hg, and CAC score >0 than men in lower tertiles. PTH was not associated with history of fracture, baseline BMD, or change in BMD over 2 years. In summary, in this cohort of healthy men, PTH levels are linearly related to adiposity and to cardiometabolic indices, but not to BMD or bone loss. These findings suggest that adiposity should be considered as an independent cause of secondary hyperparathyroidism, and they may be relevant to patients with normocalcemic hyperparathyroidism, in whom high PTH levels may be a marker of adiposity and cardiometabolic risk rather than always indicating parathyroid autonomy.
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El Hilali J, de Koning EJ, van Ballegooijen AJ, Lips P, Sohl E, van Marwijk HWJ, Visser M, van Schoor NM. Vitamin D, PTH and the risk of overall and disease-specific mortality: Results of the Longitudinal Aging Study Amsterdam. J Steroid Biochem Mol Biol 2016; 164:386-394. [PMID: 26678328 DOI: 10.1016/j.jsbmb.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/20/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
Abstract
Observational studies suggest that low concentrations of serum 25-hydroxyvitamin D (25(OH)D) and high concentrations of parathyroid hormone (PTH) are associated with a higher risk of mortality. The aim of this study was to examine whether 25(OH)D and PTH concentrations are independently associated with overall and disease-specific (cardiovascular and cancer-related) mortality in a large, prospective population-based cohort of older adults. Data from 1317 men and women (65-85 years) of the Longitudinal Aging Study Amsterdam were used. Cox proportional hazard analyses were used to examine whether 25(OH)D and PTH at baseline were associated with overall mortality (with a follow-up of 18 years) and disease-specific mortality (with a follow-up of 13 years). Compared to persons in the reference category of ≥75nmol/L, persons with serum 25(OH)D <25nmol/L (HR 1.46; 95% CI: 1.12-1.91) and 25-49.9nmol/L (HR 1.24; 95% CI: 1.01-1.53) had a significantly higher risk of overall mortality, as well as men with baseline PTH concentrations ≥7pmol/L (HR 2.54 (95% CI: 1.58-4.08)), compared to the reference category of <2.33pmol/L. The relationship of 25(OH)D with overall mortality was partly mediated by PTH. Furthermore, men with PTH concentrations of ≥7pmol/L (HR 3.22; 95% CI: 1.40-7.42) had a higher risk of cardiovascular mortality, compared to the reference category. No significant associations of 25(OH)D or PTH with cancer-related mortality were observed. Both 25(OH)D and PTH should be considered as important health markers.
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Affiliation(s)
- Jamila El Hilali
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Elisa J de Koning
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Adriana J van Ballegooijen
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Health Sciences, VU University, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Paul Lips
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Evelien Sohl
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Harm W J van Marwijk
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Primary Care Research Center, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Marjolein Visser
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Health Sciences, VU University, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Internal Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
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Kim JH, Baggish AL. Physical Activity, Endurance Exercise, and Excess—Can One Overdose? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:68. [DOI: 10.1007/s11936-016-0490-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Pepe J, Diacinti D, Fratini E, Nofroni I, D'Angelo A, Pilotto R, Savoriti C, Colangelo L, Raimo O, Cilli M, Cipriani C, Minisola S. High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score. Eur J Endocrinol 2016; 175:95-100. [PMID: 27165861 DOI: 10.1530/eje-15-1152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/06/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The prevalence of abdominal aortic calcification (AAC) in primary hyperparathyroidism (PHPT) is unknown. We assessed both prevalence and severity of AAC in PHPT postmenopausal women. METHODS In this study 70 PHPT postmenopausal women and 70 age- and sex-matched controls were enrolled. Each participant underwent biochemical evaluation, lateral spine radiograph, bone mineral density (BMD) measurement (lumbar, femoral, radial sites), and kidney ultrasound. Lateral lumbar films were analyzed in the region of L1-L4 vertebrae and the Kauppila score (a semi-quantitative grading system) was used to assess the severity of AAC. RESULTS There were no differences regarding demographic and cardiovascular risk factors in the two groups. PHPT patients had higher prevalence of kidney stones (30% vs 7%, P=0.0008) and lower radial BMD values (0.558±0.071 vs 0.588±0.082 g/cm(2), P<0.05) compared with controls. PHPT patients showed higher prevalence of AAC (31 vs 18, P=0.03), with more severe calcifications (Kauppila score 7.35±6.1 vs 5.05±3.5, P=0.007). PHPT patients with AAC were older and had been suffering from the disease for a longer period compared with those without ACC. Moreover, PHPT patients with severe AAC had mean higher serum parathyroid hormone levels compared with patients with moderate or mild calcifications. In PHPT patients with AAC, multiple regression analysis, adjusted for age and years since diagnosis, showed that only parathyroid hormone significantly correlated with Kauppila score. CONCLUSION We found a higher prevalence and severity of AAC in PHPT related to parathyroid hormone effect.
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Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology'Sapienza' University, Rome, Italy
| | - Emanuela Fratini
- Department of Radiological Sciences, Oncology and Pathology'Sapienza' University, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases'Sapienza' University, Rome, Italy
| | - Antonella D'Angelo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Roberta Pilotto
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Claudio Savoriti
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Luciano Colangelo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Orlando Raimo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Mirella Cilli
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
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Abstract
Objective: Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and parathyroid hormone (PTH) levels. Here, we aimed to evaluate the association between PTH levels and severity of CAD. Methods: Patients were divided into two groups based on their serum PTH values. Patients with PTH levels ≤72 pg/mL were accepted as Group 1 (n=568) and >72 pg/mL as Group 2 (n=87). Gensini score system and >50% stenosis in any coronary artery with conventional coronary angiography were used to determine the extensiveness of CAD. This study was designed as a prospective and cross-sectional study. Results: Baseline characteristics except for age, gender, and blood pressure were similar between groups. Mean serum PTH levels of the entire cohort was 43.4±29.5 pg/mL. Median Gensini score was 19.5 in Group 1 and 14.5 in Group 2 (p=0.75). On the other hand, PTH levels were weakly correlated with Gensini score (Spearman’s Rho=0.11, p=0.003). Additionally, we did not observe a statistically significant difference between PTH levels and the number of stenotic vessels (p=0.14). This study was designed as a prospective and cross-sectional study. Conclusion: There is no association between serum PTH levels and extensiveness of CAD.
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Yap YS, Ting KT, Chi WC, Lin CH, Liu YC, Chuang WL. Aortic Arch Calcification Predicts Patency Loss of Arteriovenous Fistula in End-Stage Renal Disease Patients. Sci Rep 2016; 6:24943. [PMID: 27101807 PMCID: PMC4840307 DOI: 10.1038/srep24943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/07/2016] [Indexed: 12/04/2022] Open
Abstract
Aortic arch calcification (AAC) is recognized as an important cardiovascular risk factor in patients with end-stage renal disease (ESRD). The aim of the study was to evaluate the impact of AAC grade on patency rates of arteriovenous fistula (AVF) in this specific population. The data of 286 ESRD patients who had an initial AVF placed were reviewed. The extent of AAC identified on chest radiography was divided into four grades (0–3). The association between AAC grade, other clinical factors, and primary patency of AVF was then analyzed by Cox proportional hazard analysis. The multivariate analysis demonstrated that the presence of AAC grade 2 (hazard ratio (95% confidence interval): 1.80 (1.15–2.84); p = 0.011) and grade 3 (3.03 (1.88–4.91); p < 0.001), and higher level of intact-parathyroid hormone (p = 0.047) were associated with primary patency loss of AVF. In subgroup analysis, which included AVF created by a surgeon assisted with preoperative vascular mapping, only AAC grade 3 (2.41 (1.45–4.00); p = 0.001), and higher intact-parathyroid hormone (p = 0.025) level were correlated with AVF patency loss. In conclusion, higher AAC grade and intact-parathyroid hormone level predicted primary patency loss of AVF in an ESRD population.
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Affiliation(s)
- Yit-Sheung Yap
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Kai-Ting Ting
- Division of Gastroenterology, Department of Internal Mednicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Wen-Che Chi
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Cheng-Hao Lin
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Liu
- Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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George JA, Norris SA, Toman M, Snyman T, Crowther NJ. Visceral adiposity is a predictor of parathyroid hormone levels in healthy adults. J Endocrinol Invest 2016; 39:447-53. [PMID: 26501363 DOI: 10.1007/s40618-015-0400-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/10/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Parathyroid hormone (PTH) has been shown to correlate positively with fat mass, however there are no studies that have investigated whether this association is a result of, or is modified by, body fat distribution. The aim of this study was to investigate the association of PTH with several body composition indices, namely visceral (VAT) and subcutaneous adiposity (SCAT) as well as with lean mass and with serum leptin, which has been reported to increase PTH. METHODS This was a cross-sectional study in which PTH was measured by chemiluminescent assay; body fat and lean mass by dual-energy X-ray absorptiometry (DXA) and abdominal fat by ultrasonography in 714 healthy adults aged 18-65 years. Serum leptin was measured by ELISA. RESULTS In a multivariate linear regression model that included height, age, gender, ethnicity, serum 25 hydroxyvitamin D, leptin levels, calcium, magnesium and phosphate concentrations, glomerular filtration rate, smoking status, and calcium and vitamin D supplementation as independent variables and PTH as the dependent variable, VAT (β = 0.094, p = 0.035) correlated significantly with PTH levels but SCAT (β = -0.045, p = 0.386) and body fat mass (β = 0.098, p = 0.126) did not. Leptin did not correlate with PTH (β = 0.013, p = 0.832) in this regression model. CONCLUSIONS Plasma PTH is significantly associated with VAT in healthy adults. In view of the association of PTH with increased cardiovascular mortality, it is important to investigate this association further.
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Affiliation(s)
- J A George
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Room 3B 41, Third Floor, Medical School, Parktown, Johannesburg, 2193, South Africa.
| | - S A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Toman
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Room 3B 41, Third Floor, Medical School, Parktown, Johannesburg, 2193, South Africa
| | - T Snyman
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Room 3B 41, Third Floor, Medical School, Parktown, Johannesburg, 2193, South Africa
| | - N J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Room 3B 41, Third Floor, Medical School, Parktown, Johannesburg, 2193, South Africa
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Larsson S, Jones HA, Göransson O, Degerman E, Holm C. Parathyroid hormone induces adipocyte lipolysis via PKA-mediated phosphorylation of hormone-sensitive lipase. Cell Signal 2016; 28:204-213. [DOI: 10.1016/j.cellsig.2015.12.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 12/19/2022]
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Eijsvogels TMH, Fernandez AB, Thompson PD. Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise? Physiol Rev 2016; 96:99-125. [PMID: 26607287 PMCID: PMC4698394 DOI: 10.1152/physrev.00029.2014] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonio B Fernandez
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul D Thompson
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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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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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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