Elevated Parathyroid Hormone, But Not Vitamin D Deficiency, Is Associated With Increased Risk of Heart Failure in Older Men With and Without Cardiovascular Disease
Background—Hyperparathyroidism and low vitamin D status have been implicated in the pathogenesis of HF We have examined the prospective associations between parathyroid hormone (PTH), circulating 25-hydroxyvitamin D (25OHD) and markers of mineral metabolism and risk of incident heart failure (HF) in older men with and without established cardiovascular disease.
Methods and Results—Prospective study of 3731 men aged 60-79 years with no prevalent HF followed up for a mean period of 13 years, in whom there were 287 incident HF cases. Elevated PTH (>55.6 pg/ml; top quarter) was associated with significantly higher risk of incident HF after adjustment for lifestyle characteristics, diabetes, blood lipids, blood pressure, lung function, heart rate, renal dysfunction, atrial fibrillation, FEV1 and CRP [hazards ratio (HR) (95%CI) 1.66(1.30,2.13). The increased risk was seen in both men with, and without previous myocardial infarction (MI) or stroke [1.72 (1.07,2.76) and 1.70 (1.25,2.30) respectively]. Elevated PTH was significantly associated with NT-proBNP, a marker of left ventricular wall stress. By contrast 25OHD and other markers of mineral metabolism including serum calcium and phosphate showed no significant association with incident HF after adjustment for age.
Conclusions—Elevated PTH but not 25OHD or other markers of mineral metabolism is associated with increased risk of HF in both older men with and without MI/stroke. This increased risk was not explained by its association with known risk factors for HF. Further studies are now needed to elucidate the mechanisms underlying this association.
- Received March 6, 2014.
- Accepted July 28, 2014.