title: Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study.
abstract: Recent studies have demonstrated greater risks of cardiovascular events and mortality among persons who have lower 25-hydroxyvitamin D (25-OHD) and higher parathyroid hormone (PTH) levels. We sought to evaluate the association between markers of mineral metabolism and sudden cardiac death (SCD) among the 2312 participants from the Cardiovascular Health Study who were free of clinical cardiovascular disease at baseline. We estimated associations of baseline 25-OHD and PTH concentrations individually and in combination with SCD using Cox proportional hazards models after adjustment for demographics, cardiovascular risk factors, and kidney function. During a median follow-up of 14 years, there were 73 adjudicated SCD events. The annual incidence of SCD was greater among subjects who had lower 25-OHD concentrations, 2 events per 1000 for 25-OHD ≥20 ng/mL and 4 events per 1000 for 25-OHD <20 ng/mL. Similarly, SCD incidence was greater among subjects who had higher PTH concentrations, 2 events per 1000 for PTH <65 pg/mL and 4 events per 1000 for PTH ≥65 pg/mL. Multivariate adjustment attenuated associations of 25-OHD and PTH with SCD. Finally, 267 participants (11.7% of the cohort) had high PTH and low 25-OHD concentrations. This combination was associated with a >2-fold risk of SCD after adjustment (hazard ratio: 2.19 [95% CI: 1.17-4.10]; P=0.017) compared with participants with normal levels of PTH and 25-OHD. The combination of lower 25-OHD and higher PTH concentrations appears to be associated independently with SCD risk among older adults without cardiovascular disease.
authors: Section of Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. Rajat.Deo@uphs.upenn.edu
authors: Rajat
authors: R
authors: Deo
authors: Ronit
authors: R
authors: Katz
authors: Michael G
authors: MG
authors: Shlipak
authors: Nona
authors: N
authors: Sotoodehnia
authors: Bruce M
authors: BM
authors: Psaty
authors: Mark J
authors: MJ
authors: Sarnak
authors: Linda F
authors: LF
authors: Fried
authors: Michel
authors: M
authors: Chonchol
authors: Ian H
authors: IH
authors: de Boer
authors: Daniel
authors: D
authors: Enquobahrie
authors: David
authors: D
authors: Siscovick
authors: Bryan
authors: B
authors: Kestenbaum
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D008903:Minerals; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D