Plasma calcidiol, calcitriol, and parathyroid hormone and risk of new onset heart failure in a population-based cohort study.
BACKGROUND
Heart failure (HF) is a major problem in the Western world, with increasing prevalence and incidence. Because HF cannot be cured, prevention of HF is of utter importance. Calcidiol, calcitriol, and parathyroid hormone (PTH) have been identified as risk factors for cardiovascular disease. However, their association with new onset HF remains to be established. We investigated whether calcidiol, calcitriol, and PTH could be used to identify those subjects at risk for new onset HF, and if they had additive predictive value over established risk predictors like N-terminal-pro Brain-type natriuretic peptide and highly sensitive Troponin-T.


RESULTS
We examined 7470 HF-free participants in Prevention of Renal and Vascular End-stage Disease, a community-based cohort study in Groningen, the Netherlands (latitude 53°N, mean age: 49 years, 48% male). During follow-up time of 12.6 years (interquartile range: 12.3-12.9), 281 participants (4%) developed HF: 181 (66%) HF with reduced and 94 (34%) HF with preserved ejection fraction (HFrEF [left ventricular ejection fraction ≤ 40%], and HFpEF [left ventricular ejection fraction ≥ 50%], respectively). Mean (±SD) of calcidiol was 58 (±24) nmol/L, mean calcitriol 145 (±48) pmol/L, and median (interquartile range) PTH was 3.7 (3.0-4.6) pmol/L. Calcidiol levels were univariately associated with new onset HF [hazard ratio (HR) 0.82 (95% CI 0.69-0.96)], but calcitriol levels were not [HR 0.85 (95% CI 0.71-1.03)]. PTH levels kept their predictive value after adjustment for age, sex, and day of blood withdrawal (HR 1.26 [95% CI 1.04-1.53]). However, in our full model this association was lost [HR 1.10 (95% CI 0.92-1.32)]. Calcidiol, calcitriol, and PTH could not differentiate between new onset HFrEF or HFpEF.


CONCLUSIONS
After adjustment for confounding factors, a single measurement of plasma calcidiol, calcitriol, or PTH was not associated with risk of developing HF. Screening for these markers to identify subjects at risk for new onset HF cannot be advocated.
Department of Cardiology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Laura M G
LM
Meems
Department of Cardiology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Frank P
FP
Brouwers
Department of Nephrology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Michel M
MM
Joosten
Department of Clinical Pharmacy and Pharmacology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Hiddo J
HJ
Lambers Heerspink
Department of Clinical Pharmacy and Pharmacology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Dick
D
de Zeeuw
Department of Nephrology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Stephan J L
SJ
Bakker
Department of Nephrology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Ron T
RT
Gansevoort
Department of Cardiology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Wiek H
WH
van Gilst
Department of Cardiology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Pim
P
van der Harst
Department of Cardiology University of Groningen, University Medical Center Groningen Groningen the Netherlands.
Rudolf A
RA
de Boer
Heart failure; Parathyroid hormone; Population studies; Risk factor; Vitamin D