Parathyroid hormone reference ranges in healthy individuals classified by vitamin D status

PURPOSE

Parathyroid hormone (PTH) concentrations are routinely measured in the diagnosis and management of bone and kidney diseases, but reference ranges can be overestimated if determined in otherwise healthy individuals for whom vitamin D deficiency was not evaluated. We establish PTH reference ranges in apparently healthy, normocalcemic, normophosphatemic individuals categorized by 25-hydroxyvitamin D (25(OH)D) status using the Elecsys^® PTH (cobas e 601) and Elecsys^® Vitamin D total II electrochemiluminescence immunoassays (cobas e 411).

METHODS

This prospective, non-interventional study measured PTH in serum from 653 apparently healthy adults [56.7% female; 68.2% white/Caucasian; 28.6% African American; median age 44 years (range 21-83)] from three diverse geographic sites across the USA during summer and winter months. Subjects were classified by concomitant vitamin D sufficiency (≥ 30 ng/mL), insufficiency (> 20 to < 30 ng/mL) or deficiency (≤ 20 ng/mL).

RESULTS

In vitamin D sufficiency, median PTH was 31.9 pg/mL [range (2.5th-97.5th percentile) 17.9-58.6] compared with 35.5 pg/mL (17.0-60.4) for insufficiency, and 39.8 pg/mL (19.5-86.4) for deficiency. A significant inverse relationship was found between PTH and 25(OH)D (P < 0.001). After accounting for vitamin D, potential effects of race or season as covariates were relatively small or absent.

CONCLUSIONS

Upper reference limits (URL) for PTH in vitamin D sufficiency/insufficiency were similar and lower than current values. Clinically important PTH elevations were observed in vitamin D deficiency, where revised reference ranges with a higher URL may be appropriate. These data may help to distinguish vitamin D-related PTH elevations from other causes [e.g., primary (normocalcemic) or secondary hyperparathyroidism].

The effects of metoprolol and captopril on heart rate variability in patients with idiopathic dilated cardiomyopathy

BACKGROUND

The effects of treatment with captopril or metoprolol on heart rate variability (HRV) were investigated in 38 patients (29 men and 9 women) with mild to moderate symptoms of heart failure due to idiopathic dilated cardiomyopathy (DCM).

HYPOTHESIS

The aim of the study was to investigate and compare the effects of the angiotensin-converting enzyme inhibitor captopril with those of the selective beta-adrenergic receptor blocker metoprolol on HRV in patients with idiopathic DCM.

METHODS

Heart rate variability was analyzed in the time and frequency domains from 18th of Holter monitoring before randomized treatment was started, after 6 months of therapy, and 1 month after therapy was stopped.

RESULTS

Captopril treatment increased HRV expressed as total power and low-frequency power in the frequency domain. There was no change in the time domain. In the metoprolol group, there was a pronounced increase in both time- and frequency-domain indices of HRV. The increase in total power was partly maintained 1 month after therapy was stopped in both treatment groups.

CONCLUSION

Treatment with captopril and metoprolol increases HRV in patients with DCM. This effect seems to be maintained for at least 1 month after therapy is stopped. The increase in HRV seems to be more pronounced with metoprolol, and the two different pharmacologic approaches may have additive effects that are of prognostic importance in patients with heart failure.

Exercise training decreases plasma cholesteryl ester transfer protein

To assess the effect of exercise on the plasma concentration of cholesterol ester transfer protein (CETP) and its possible influence in mediating the exercise-associated redistribution of cholesterol among plasma lipoproteins, we measured plasma CETP in 57 healthy normolipidemic men and women before and after 9 to 12 months of exercise training. The training protocol resulted in significant changes in VO2max (mean +/- SD, +5.3 +/- 3.5 mL.kg-1 x min-1), body weight (-2.5 +/- 3.5 kg), plasma triglycerides (-25.7 +/- 36.3 mg/dL), high-density lipoprotein cholesterol (HDL-C) (+2.6 +/- 6.2 mg/dL), and ratios of total cholesterol to HDL-C (-0.30 +/- 0.52) and low-density lipoprotein cholesterol (LDL-C) to HDL-C (-0.18 +/- 0.45) (all P < or = .05) but no change in lipoprotein(a). CETP concentration (in milligrams per liter) fell significantly in response to training in both men (n = 28, 2.47 +/- 0.66 to 2.12 +/- 0.43; % delta = 14.2%; P < .005) and women (n = 29, 2.72 +/- 1.01 to 2.36 +/- 0.76; % delta = 13.2%; P < .047). The CETP change was observed both in subjects who lost weight (n = 28, delta mean weight = -5.0 kg; delta CETP = -0.42 +/- 0.79; % delta = 15.4%; P < .009) and in those who were weight stable (n = 29, delta mean weight = -0.12 kg; delta CETP = -0.29 +/- 0.78; % delta = 10.4%; P < .055).(ABSTRACT TRUNCATED AT 250 WORDS)

Predictors of the outcome of disability pension for alcohol abusers

A multi-variate multiple regression analysis was carried out to screen the crucial characteristics of alcohol abusers immediately prior to pension in order to indicate their subsequent trends. Stepwise multiple regression analyses were performed in the younger and older subgroups, as well as in 56 first-time pension applicants, in a region of the county of Ostergötland in Sweden. In the analyses, changes, over a 2-year interval, of composite scores on overall well-being, psychiatric status, need satisfaction and intellectual capacity, together with changes in alcohol consumption and gamma-GT-value, functioned as dependent variables. Eighty-five parameters of the abusers' quality of life at pension served as independent variables. The features that were seen, in various constellations, to be significantly related to non-improvement rather than to improvement were: an abrupt change-over from a previously active life, longer education, middle age, tendencies to passivity and to social confinement, worse observed psychiatric status in contrast to less bad reported status, relatively better self-rated well-being, remaining intellectual resources, black-outs, a lower current alcohol consumption, lower gamma-GT, S-NAP, S-ALAT- and S-protein-values together with more elevated P-IgA, P-ALP-, S-creatinine- and S-Ca-corrected values. The results are discussed with reference to their general applicability, plausible mechanisms in a pension situation, previously launched hypotheses, and the methodological limitations of the study. It is concluded that a literal application of the results in practice must be made with caution.

Structure, immunology, and cell reactivity of low density lipoprotein from umbilical vein of a newborn type II homozygote

In this report we compare the cord blood lipoproteins of a newborn boy homozygote who has low density lipoprotein (LDL) receptor-defective familial hypercholesterolemia (FH) with the lipoproteins from cord blood of normal newborns. Plasma LDL-cholesterol and apoprotein (Apo)B were 612 and 233 mg/dl (vs. 31+/-16 and 24+/-12 mg/dl, respectively, for normals, n = 21). LDL-cholesterol/ApoB ratio was 2.6 vs. 1.4+/-0.5. Levels of ApoA-I, ApoA-II, and HDL-cholesterol were similar to normal cord plasma. Thus, the lipoprotein abnormality is apparent at birth and is definitely present in LDL. Abnormalities in other lipoprotein, lipid, and in plasma apoprotein levels were not detected. On zonal ultracentrifugation, FH LDL was comprised of two populations (LDL(a) and LDL(b)), both faster floating than normal cord LDL (LDL(c)). This difference was due to the larger diameters of the particles on electron microscopy (LDL(a) = 276A+/-32 and LDL(b) = 260A+/-38 vs. LDL(c) = 237A+/-26, n = 200 each, mean+/-1 SD), and their higher contents of lipids relative to protein (86 and 82% vs. 74%, LDL(a), LDL(b), and LDL(c), respectively). More than 94% of the protein in both the FH and the normal preparations consisted of ApoB. FH LDL were more effective than control LDL in competing with (125)I-LDL (adult) for limiting amounts of anti-LDL antibodies in radioimmunoassay. FH LDL also competed more effectively for binding to LDL receptors on cultured fibroblasts at 4 degrees C, and FH LDL also delivered more cholesterol into the cells. Cells grown in lipoprotein-deficient serum contained 44+/-2 mug cholesterol/mg cell protein, incubation of cells for 18 h at 37 degrees C in 5 mug/ml FH LDL (protein) or in normal LDL raised cellular cholesterol levels to 75+/-2 and 60+/-2 mug/mg, respectively.LDL isolated from the FH patient's plasma at 6 mo of age and from his brother's plasma (a 5-yr-old boy FH homozygote) were similar to LDL isolated from normolipemic subjects in flotation properties, chemical composition, and immunochemical and cell reactivity. The fact that differences between normal cord LDL and FH cord LDL were present at birth, but that the differences between control and FH LDL were no longer present postnatally suggests that the altered immunologic and cell interactive properties of FH cord LDL were probably related to its unusually high contents of core lipids.