Cardiovascular Department, Intermountain Medical Center, Murray, UT 84107-5701, USA.
Am Heart J. 2011 Aug;162(2):331-339.e2. doi: 10.1016/j.ahj.2011.05.005.
Vitamin D (Vit D) deficiency has been associated with prevalent and incident cardiovascular (CV) disease, suggesting a role for bioregulators of bone and mineral metabolism in CV health. Vitamin D deficiency leads to secondary hyperparathyroidism, and both primary and secondary hyperparathyroidism are associated with CV pathology. Parathyroid hormone (PTH) is an important regulator of calcium homeostasis, and its impact on CV disease risk is of interest. We tested whether elevated PTH is associated with CV disease and whether risk associations depend on Vit D status and renal function.
Patients in the Intermountain Healthcare system with concurrent PTH and Vit D as 25-hydroxy-vitamin D (25[OH]D) levels were studied (N = 9,369, age 63 ± 16 years, 36% male). Parathyroid hormone levels were defined as low (<15 pg/mL), normal (15-75 pg/mL), or elevated (>75 pg/mL). Prevalence and incidence of hypertension, diabetes, hyperlipidemia, coronary artery disease/myocardial infarction, heart failure, stroke, and peripheral vascular disease were determined by the International Classification of Diseases, Ninth Revision codes documented in electronic medical records at baseline and, for incident events, during an average of 2.0 ± 1.5 years (maximum 7.5 years) of follow-up.
Parathyroid hormone elevation at baseline was noted in 26.1% of the study population. Highly significant differential CV prevalence/incidence rates for most CV risk factors, disease diagnoses, and mortality were noted for PTH >75 pg/mL (by 1.25- to 3-fold). Parathyroid hormone correlated only weakly (r = -0.15) with 25(OH)D and moderately with glomerular filtration rate (r = -0.36). 25(OH)D, standard risk factors, and renal dysfunction variably attenuated PTH risk associations, but risk persisted after full multivariable adjustment.
Elevated PTH is associated with a greater prevalence and incidence of CV risk factors and predicts a greater likelihood of prevalent and incident disease, including mortality. Risk persists when adjusted for 25(OH)D, renal function, and standard risk factors. Parathyroid hormone represents an important new CV risk factor that adds complementary and independent predictive value for CV disease and mortality.
维生素 D（Vit D）缺乏与心血管疾病（CV）的普遍和发病有关，这表明骨和矿物质代谢的生物调节剂在 CV 健康中发挥作用。维生素 D 缺乏导致继发性甲状旁腺功能亢进，原发性和继发性甲状旁腺功能亢进均与 CV 病理有关。甲状旁腺激素（PTH）是钙稳态的重要调节剂，其对 CV 疾病风险的影响受到关注。我们检测了升高的 PTH 是否与 CV 疾病相关，以及风险关联是否取决于 Vit D 状态和肾功能。
对 Intermountain Healthcare 系统中同时具有甲状旁腺激素和 Vit D（25-羟维生素 D（25[OH]D）水平）的患者进行了研究（N=9369，年龄 63±16 岁，36%为男性）。甲状旁腺激素水平定义为低（<15 pg/mL）、正常（15-75 pg/mL）或升高（>75 pg/mL）。通过电子病历中的国际疾病分类，第九版代码在基线时确定高血压、糖尿病、血脂异常、冠状动脉疾病/心肌梗死、心力衰竭、中风和外周血管疾病的患病率和发病率，对于发病事件，在平均 2.0±1.5 年（最长 7.5 年）的随访期间确定。
研究人群中有 26.1%的患者存在甲状旁腺激素升高。对于大多数 CV 危险因素、疾病诊断和死亡率，甲状旁腺激素>75 pg/mL 的差异具有显著的 CV 患病率/发病率（增加 1.25-3 倍）。甲状旁腺激素仅与 25（OH）D 弱相关（r=-0.15），与肾小球滤过率中度相关（r=-0.36）。25（OH）D、标准危险因素和肾功能障碍可不同程度地减弱甲状旁腺激素风险关联，但在充分多变量调整后风险仍然存在。
升高的 PTH 与更多的 CV 危险因素的患病率和发病率相关，并预测更常见的和发病的疾病，包括死亡率。当调整 25（OH）D、肾功能和标准危险因素时，风险仍然存在。甲状旁腺激素是一种重要的新的 CV 危险因素，为 CV 疾病和死亡率提供了补充和独立的预测价值。
