Published online before print May 18, 2009, doi: 10.1161/CIRCULATIONAHA.108.808733
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2009;119:2765-2771.)
© 2009 American Heart Association, Inc.
Epidemiology |
Plasma Parathyroid Hormone and the Risk of Cardiovascular Mortality in the Community
From Uppsala Clinical Research Center (E.H., L.B., C.H., K.M.), Department of Surgical Sciences, (E.H., P.H., K.M.), Department of Public Health and Caring Sciences/Geriatrics (E.I., J.Ä.), and Department of Medical Sciences (T.E.L., J.S., H.M., L.L.), Uppsala University, Uppsala; Departments of Medical Epidemiology and Biostatistics (E.I) and Nephrology (T.E.L.), Karolinska Institutet, Stockholm; and the Department of Health and Social Sciences (J.Ä.), Högskolan Dalarna, Falun, Sweden.
Correspondence to Emil Hagström, MD, PhD, Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden. E-mail emil.hagstrom{at}ucr.uu.se
Received July 25, 2008; accepted March 26, 2009.
Background— Diseases with elevated levels of parathyroid hormone (PTH) such as primary and secondary hyperparathyroidism are associated with increased incidence of cardiovascular disease and death. However, data on the prospective association between circulating PTH levels and cardiovascular mortality in the community are lacking.
Methods and Results— The Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men (mean age, 71 years; n=958), was used to investigate the association between plasma PTH and cardiovascular mortality. During follow-up (median, 9.7 years), 117 participants died of cardiovascular causes. In Cox proportional-hazards models adjusted for established cardiovascular risk factors (age, systolic blood pressure, diabetes, smoking, body mass index, total cholesterol, high-density lipoprotein cholesterol, antihypertensive treatment, lipid-lowering treatment, and history of cardiovascular disease), higher plasma PTH was associated with higher risk for cardiovascular mortality (hazard ratio for 1-SD increase in PTH, 1.38; 95% confidence interval, 1.18 to 1.60; P<0.001). This association remained essentially unaltered in participants without previous cardiovascular disease and in participants with normal PTH (<6.8 pmol/L) with no other signs of a disturbed mineral metabolism (normal serum calcium, 2.2 to 2.6 mmol/L; normal glomerular filtration rate, >50 mL · min–1 · 1.73 m–2 and without vitamin D deficiency, plasma 25-OH vitamin D >37.5 nmol/L). Interestingly, elevated plasma PTH (>5.27 pmol/L) accounted for 20% (95% confidence interval, 10 to 26) of the population-attributable risk proportion for cardiovascular mortality.
Conclusions— Plasma PTH levels predict cardiovascular mortality in the community, even in individuals with PTH within the normal range. Further studies are warranted to evaluate the clinical implications of measuring PTH in cardiovascular risk prediction and to elucidate whether PTH is a modifiable risk factor.
CLINICAL PERSPECTIVE
Related Article:
-
Circulation: Clinical Summaries
Circulation 2009 119: 2749-2751.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  S. Pilz, A. Tomaschitz, C. Drechsler, E. Ritz, B. O. Boehm, T. B. Grammer, and W. Marz Parathyroid hormone level is associated with mortality and cardiovascular events in patients undergoing coronary angiography Eur. Heart J., July 1, 2010; 31(13): 1591 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. D. Parker, L. J. Schurgers, V. M. Brandenburg, R. H. Christenson, C. Vermeer, M. Ketteler, M. G. Shlipak, M. A. Whooley, and J. H. Ix The Associations of Fibroblast Growth Factor 23 and Uncarboxylated Matrix Gla Protein With Mortality in Coronary Artery Disease: The Heart and Soul Study Ann Intern Med, May 18, 2010; 152(10): 640 - 648. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Everett Markers of Mineral Metabolism and Cardiovascular Disease Ann Intern Med, May 18, 2010; 152(10): 683 - 684. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Hutchinson, G. Grimnes, R. M. Joakimsen, Y. Figenschau, and R. Jorde Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromso study Eur. J. Endocrinol., May 1, 2010; 162(5): 935 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Sanz, P. R. Moreno, and V. Fuster The Year in Atherothrombosis J. Am. Coll. Cardiol., April 6, 2010; 55(14): 1487 - 1498. [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Ix, M. G. Shlipak, C. L. Wassel, and M. A. Whooley Fibroblast growth factor-23 and early decrements in kidney function: the Heart and Soul Study Nephrol. Dial. Transplant., March 1, 2010; 25(3): 993 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Virdis, F. Cetani, C. Giannarelli, C. Banti, L. Ghiadoni, E. Ambrogini, D. Carrara, A. Pinchera, S. Taddei, G. Bernini, et al. The Sulfaphenazole-Sensitive Pathway Acts as a Compensatory Mechanism for Impaired Nitric Oxide Availability in Patients with Primary Hyperparathyroidism. Effect of Surgical Treatment J. Clin. Endocrinol. Metab., February 1, 2010; 95(2): 920 - 927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hjelmesaeth, J. Roislien, D. Hofso, and J. Bollerslev Plasma 25-Hydroxyvitamin D Concentration and Metabolic Syndrome Among Middle-Aged and Elderly Chinese Individuals: Response to Lu et al. Diabetes Care, January 1, 2010; 33(1): e13 - e13. [Full Text] [PDF]
|
|