title: Parathyroid hormone and vitamin D--markers for cardiovascular and all cause mortality in heart failure.
abstract: OBJECTIVE
  To investigate levels of vitamin D and parathyroid hormone (PTH) in a population of heart failure (HF) patients, and to evaluate whether vitamin D and PTH are related to prognosis.
  
  
  RESULTS
  This was a prospective study of 148 HF outpatients (mean age 68 years, 102 men) with follow-up for mortality after 3½ years. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), PTH, 25-hydroxyvitamin D (25-OHD), and several other biomarkers were examined. Mortality and cardiovascular mortality were analysed in multivariable regression analyses adjusting for other independent prognostic variables. Vitamin D deficiency (≤50 nmol/L) was prevalent in 43% of the population; 26% had elevated PTH levels; none had primary hyperparathyroidism. We found a strong and independent significant association of both PTH and vitamin D to mortality, which was independent of other clinically important parameters [NT-proBNP, estimated glomerular filtration rate (eGFR), age, and left ventricular ejection fraction (LVEF)]. Both PTH and vitamin D were also significantly associated with all cause mortality. In an adjusted model, we found a hazard ratio of 1.9 (confidence interval 1.1-3.4) for vitamin D deficiency and 2.0 (1.0-3.8) for the upper median of PTH, respectively.
  
  
  CONCLUSIONS
  In this relatively small prospective study, PTH and vitamin D were independently associated with all cause and cardiovascular mortality in patients with HF. This was independent of other known risk factors such as eGFR, LVEF, NT-proBNP, and age.
authors.affiliation: Department of Endocrinology, Hvidovre Hospital, Denmark. Louise.Schierbeck@gmail.com
authors.forename: Louise Lind
authors.initials: LL
authors.lastname: Schierbeck
authors.forename: Torben Slott
authors.initials: TS
authors.lastname: Jensen
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bang
authors.forename: Gorm
authors.initials: G
authors.lastname: Jensen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Jens-Erik Beck
authors.initials: JE
authors.lastname: Jensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D