title: Elevated parathyroid hormone, but not vitamin D deficiency, is associated with increased risk of heart failure in older men with and without cardiovascular disease.
abstract: BACKGROUND
  Hyperparathyroidism and low vitamin D status have been implicated in the pathogenesis of heart failure (HF). We examined the prospective associations between parathyroid hormone (PTH), circulating 25-hydroxyvitamin D, and markers of mineral metabolism and risk of incident HF in older men with and without established cardiovascular disease.
  
  
  RESULTS
  Prospective study of 3731 men aged 60 to 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 mellitus, blood lipids, blood pressure, lung function, heart rate, renal dysfunction, atrial fibrillation, forced expiratory volume in 1 second, and C-reactive protein (hazards ratio, 1.66; 95% confidence interval, 1.30-2.13). The increased risk was seen in both men with and without previous myocardial infarction or stroke (hazards ratio, 1.72; 95% confidence interval, 1.07-2.76; hazards ratio, 1.70; 95% confidence interval, 1.25-2.30, respectively). Elevated PTH was significantly associated with N-terminal probrain natriuretic peptide, a marker of left ventricular wall stress. By contrast, 25-hydroxyvitamin D 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 25-hydroxyvitamin D or other markers of mineral metabolism, is associated with increased risk of HF in both older men with and without myocardial infarction/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.
authors.affiliation: From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.). g.wannamethee@ucl.ac.uk.
authors.forename: S Goya
authors.initials: SG
authors.lastname: Wannamethee
authors.affiliation: From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.affiliation: From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
authors.forename: Olia
authors.initials: O
authors.lastname: Papacosta
authors.affiliation: From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
authors.forename: Lucy
authors.initials: L
authors.lastname: Lennon
authors.affiliation: From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
authors.forename: Peter H
authors.initials: PH
authors.lastname: Whincup
authors.affiliation: From the Department of Primary Care and Population Health, University College London, London, United Kingdom (S.G.W., O.P., L.L.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (P.W., N.S.); and Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.H.W.).
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D010281:Parathyroid Hormone / Q000097:blood*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: heart failure; parathyroid hormone; vitamin D