Plasma parathyroid hormone and risk of congestive heart failure in the community.
OBJECTIVE
In experimental studies parathyroid hormone (PTH) has been associated with underlying causes of heart failure (HF) such as atherosclerosis, left ventricular hypertrophy, and myocardial fibrosis. Individuals with increased levels of PTH, such as primary or secondary hyperparathyroidism patients, have increased risk of ischaemic heart disease and HF. Moreover, increasing PTH is associated with worse prognosis in patients with overt HF. However, the association between PTH and the development HF in the community has not been reported.


RESULTS
In a prospective, community-based study of 864 elderly men without HF or valvular disease at baseline (mean age 71 years, the ULSAM study) the association between plasma (P)-PTH and HF hospitalization was investigated adjusted for established HF risk factors (myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and hypercholesterolaemia) and variables reflecting mineral metabolism (S-calcium, S-phosphate, P-vitamin D, S-albumin, dietary calcium and vitamin D intake, physical activity, glomerular filtration rate, and blood draw season). During follow-up (median 8 years), 75 individuals were hospitalized due to HF. In multivariable Cox-regression analyses, higher P-PTH was associated with increased HF hospitalization (hazard ratio for 1-SD increase of PTH, 1.41, 95% CI 1.12-1.77, P = 0.003). Parathyroid hormone also predicted hospitalization in participants without apparent ischaemic HF and in participants with normal P-PTH.


CONCLUSIONS
In a large community-based sample of elderly men, PTH predicted HF hospitalizations, also after accounting for established risk factors and mineral metabolism variables.  Our data suggest a role for PTH in the development of HF even in the absence of overt hyperparathyroidism.
Hagström
Emil
E
Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden. emil.hagstrom@ucr.uu.se
Ingelsson
Erik
E
Sundström
Johan
J
Hellman
Per
P
Larsson
Tobias E
TE
Berglund
Lars
L
Melhus
Håkan
H
Held
Claes
C
Michaëlsson
Karl
K
Lind
Lars
L
Arnlöv
Johan
J
D000368:Aged; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood* / Q000502:physiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment
D010281:Parathyroid Hormone