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Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: Dependent or independent risk factors?

The American heart journal, 2011-08, Vol.162 (2), p.331-339.e2 [Peer Reviewed Journal]

Mosby, Inc. ;2011 Mosby, Inc. ;2015 INIST-CNRS ;Copyright © 2011 Mosby, Inc. All rights reserved. ;Copyright Elsevier Limited Aug 2011 ;ISSN: 0002-8703 ;EISSN: 1097-6744 ;DOI: 10.1016/j.ahj.2011.05.005 ;PMID: 21835295 ;CODEN: AHJOA2

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Title:
Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: Dependent or independent risk factors?
Author: Anderson, Jeffrey L., MD ; Vanwoerkom, Ryan C., MD ; Horne, Benjamin D., PhD, MPH ; Bair, Tami L., BS ; May, Heidi T., PhD, MSPH ; Lappé, Donald L., MD ; Muhlestein, Joseph B., MD
Subjects: Aged ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Biomarkers - blood ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Codes ; Diabetes ; Disease Progression ; Female ; Follow-Up Studies ; Glomerular Filtration Rate - physiology ; Health care policy ; Heart attacks ; Humans ; Hyperparathyroidism, Secondary - blood ; Hyperparathyroidism, Secondary - complications ; Hyperparathyroidism, Secondary - epidemiology ; Hypertension ; Immunoassay ; Incidence ; Laboratories ; Male ; Medical sciences ; Middle Aged ; Mortality ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Parathyroid Hormone - blood ; Population ; Predictive Value of Tests ; Prognosis ; Renal failure ; Renal Insufficiency - complications ; Renal Insufficiency - epidemiology ; Renal Insufficiency - physiopathology ; Retrospective Studies ; Risk Factors ; Stroke ; Utah - epidemiology ; Vitamin D ; Vitamin D - blood ; Vitamin D Deficiency - blood ; Vitamin D Deficiency - complications ; Vitamin D Deficiency - epidemiology ; Vitamin deficiency
Is Part Of: The American heart journal, 2011-08, Vol.162 (2), p.331-339.e2
Description: Background Vitamin D (Vit D) deficiency has been associated with prevalent and incident cardiovascular (CV) disease, suggesting a role for bioregulators of bone and mineral metabolism in CV health. Vitamin D deficiency leads to secondary hyperparathyroidism, and both primary and secondary hyperparathyroidism are associated with CV pathology. Parathyroid hormone (PTH) is an important regulator of calcium homeostasis, and its impact on CV disease risk is of interest. We tested whether elevated PTH is associated with CV disease and whether risk associations depend on Vit D status and renal function. Methods Patients in the Intermountain Healthcare system with concurrent PTH and Vit D as 25-hydroxy-vitamin D (25[OH]D) levels were studied (N = 9,369, age 63 ± 16 years, 36% male). Parathyroid hormone levels were defined as low (<15 pg/mL), normal (15-75 pg/mL), or elevated (>75 pg/mL). Prevalence and incidence of hypertension, diabetes, hyperlipidemia, coronary artery disease/myocardial infarction, heart failure, stroke, and peripheral vascular disease were determined by the International Classification of Diseases, Ninth Revision codes documented in electronic medical records at baseline and, for incident events, during an average of 2.0 ± 1.5 years (maximum 7.5 years) of follow-up. Results Parathyroid hormone elevation at baseline was noted in 26.1% of the study population. Highly significant differential CV prevalence/incidence rates for most CV risk factors, disease diagnoses, and mortality were noted for PTH >75 pg/mL (by 1.25- to 3-fold). Parathyroid hormone correlated only weakly ( r = −0.15) with 25(OH)D and moderately with glomerular filtration rate ( r = −0.36). 25(OH)D, standard risk factors, and renal dysfunction variably attenuated PTH risk associations, but risk persisted after full multivariable adjustment. Conclusions Elevated PTH is associated with a greater prevalence and incidence of CV risk factors and predicts a greater likelihood of prevalent and incident disease, including mortality. Risk persists when adjusted for 25(OH)D, renal function, and standard risk factors. Parathyroid hormone represents an important new CV risk factor that adds complementary and independent predictive value for CV disease and mortality.
Publisher: New York, NY: Mosby, Inc
Language: English
Identifier: ISSN: 0002-8703
EISSN: 1097-6744
DOI: 10.1016/j.ahj.2011.05.005
PMID: 21835295
CODEN: AHJOA2
Source: AUTh Library subscriptions: ProQuest Central
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Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: Dependent or independent risk factors?

Mosby, Inc. ;2011 Mosby, Inc. ;2015 INIST-CNRS ;Copyright © 2011 Mosby, Inc. All rights reserved. ;Copyright Elsevier Limited Aug 2011 ;ISSN: 0002-8703 ;EISSN: 1097-6744 ;DOI: 10.1016/j.ahj.2011.05.005 ;PMID: 21835295 ;CODEN: AHJOA2

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