Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden.
Eur J Heart Fail. 2010 Nov;12(11):1186-92. doi: 10.1093/eurjhf/hfq134. Epub 2010 Aug 26.
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.
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.
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.
在实验研究中，甲状旁腺激素（PTH）与心力衰竭（HF）的潜在病因有关，如动脉粥样硬化、左心室肥厚和心肌纤维化。甲状旁腺激素水平升高的个体，如原发性或继发性甲状旁腺功能亢进患者，缺血性心脏病和 HF 的风险增加。此外，PTH 水平升高与明显 HF 患者的预后较差相关。然而，在社区人群中，PTH 与 HF 发展之间的关系尚未报道。
在一项前瞻性、基于社区的 864 名基线时无 HF 或瓣膜疾病的老年男性（平均年龄 71 岁，ULSAM 研究）的研究中，研究了血浆（P）-PTH 与 HF 住院之间的关系，调整了已确立的 HF 危险因素（心肌梗死、高血压、糖尿病、心电图左心室肥厚、吸烟和高胆固醇血症）和反映矿物质代谢的变量（S-钙、S-磷、P-维生素 D、S-白蛋白、饮食钙和维生素 D 摄入、体力活动、肾小球滤过率和采血季节）。在随访期间（中位数 8 年），有 75 人因 HF 住院。在多变量 Cox 回归分析中，较高的 P-PTH 与 HF 住院增加相关（PTH 增加 1-SD 的风险比，1.41，95%CI 1.12-1.77，P=0.003）。甲状旁腺激素还预测了无明显缺血性 HF 参与者和 P-PTH 正常参与者的住院。
在一项大型基于社区的老年男性样本中，PTH 预测 HF 住院，即使在考虑了已确立的危险因素和矿物质代谢变量后也是如此。我们的数据表明，即使在没有明显甲状旁腺功能亢进的情况下，PTH 也在 HF 的发展中起作用。
