Walker Marcella D, Cong Elaine, Kepley Anna, Di Tullio Marco R, Rundek Tatjana, Homma Shunichi, Lee James A, Liu Rui, Young Polly, Zhang Chiyuan, McMahon Donald J, Silverberg Shonni J
Departments of Medicine (M.D.W., E.C., A.K., M.R.D.T., S.H., R.L., P.Y., C.Z., D.J.M., S.J.S.) and Surgery (J.A.L.), Columbia University, College of Physicians and Surgeons, New York, New York 10032; and Department of Neurology (T.R.), Miller School of Medicine, University of Miami, Miami, Florida 33136.
J Clin Endocrinol Metab. 2014 Feb;99(2):671-80. doi: 10.1210/jc.2013-3523. Epub 2013 Nov 27.
Vitamin D (25OHD) deficiency may be a modifiable cardiovascular (CV) risk factor. 25OHD insufficiency (20-29 ng/mL) and deficiency (<20 ng/mL) are common in primary hyperparathyroidism (PHPT), but their association with CV disease in PHPT has not been systematically investigated.
This study evaluated whether low 25OHD is associated with subclinical CV disease in PHPT.
This is a cross-sectional analysis of PHPT patients with and without low 25OHD.
We studied 110 PHPT patients in a university hospital setting.
We measured carotid intima-media thickness; carotid plaque presence/thickness; carotid strain and stiffness; left ventricular mass index; cardiac systolic and diastolic function; and mitral annular calcification.
Low 25OHD levels (<30 ng/mL) were observed in 28%, but only 9% had 25OHD deficiency (<20 ng/mL). In the whole group, 25OHD levels negatively correlated with body mass index (r = -0.33, P = .0005), PTH (r = -0.30, P = .001), calcium (r = -0.29, P = .002), renal function, and PHPT duration. CV indices were normal except for carotid intima-media thickness, stiffness, and plaque thickness, which were increased, regardless of 25OHD status. Isovolumic relaxation time was the only CV measure associated with 25OHD (r = -0.26, P = .01). Those with 25OHD less than 20 ng/mL had more severe PHPT and a higher rate of nephrolithiasis. Those with 25OHD less than 30 ng/mL were younger, had higher body mass index, had lower serum phosphate, and were more likely to be male, nonwhite, and Hispanic. Other than lower tissue Doppler e' and higher isovolumic relaxation time within normal range in those with 25OHD less than 30 vs greater than 30 ng/mL, there were no differences in CV indices using either 25OHD threshold.
Patients with mild PHPT have subclinical carotid abnormalities, but low 25OHD is not associated with abnormal carotid or cardiac measures. To the extent that PTH levels differentiated those with 25OHD less than 20 but not 30 ng/mL, these data support a 25OHD threshold of 20 ng/mL as clinically relevant in PHPT.
维生素D（25羟维生素D）缺乏可能是一种可改变的心血管（CV）危险因素。25羟维生素D不足（20 - 29 ng/mL）和缺乏（<20 ng/mL）在原发性甲状旁腺功能亢进症（PHPT）中很常见，但其与PHPT患者心血管疾病的关联尚未得到系统研究。
本研究评估低25羟维生素D是否与PHPT患者的亚临床心血管疾病相关。
这是一项对有或无低25羟维生素D的PHPT患者的横断面分析。
我们在一家大学医院环境中研究了110例PHPT患者。
我们测量了颈动脉内膜中层厚度；颈动脉斑块的存在/厚度；颈动脉应变和硬度；左心室质量指数；心脏收缩和舒张功能；以及二尖瓣环钙化。
28%的患者观察到低25羟维生素D水平（<30 ng/mL），但只有9%的患者存在25羟维生素D缺乏（<20 ng/mL）。在整个研究组中，25羟维生素D水平与体重指数呈负相关（r = -0.33，P = 0.0005）、甲状旁腺激素（r = -0.30，P = 0.00)、钙（r = -0.29，P = 0.002）、肾功能和PHPT病程。除了颈动脉内膜中层厚度、硬度和斑块厚度增加外，心血管指标均正常，且与25羟维生素D状态无关。等容舒张时间是唯一与25羟维生素D相关的心血管指标（r = -0.26，P = 0.01）。25羟维生素D低于20 ng/mL的患者PHPT更严重，肾结石发生率更高。25羟维生素D低于30 ng/mL的患者更年轻，体重指数更高，血清磷酸盐更低，且更可能为男性、非白种人和西班牙裔。除了25羟维生素D低于30 ng/mL的患者与高于3 ng/mL的患者相比，组织多普勒e'较低且正常范围内等容舒张时间较长外，使用任何一个25羟维生素D阈值时心血管指标均无差异。
轻度PHPT患者存在亚临床颈动脉异常，但低25羟维生素D与颈动脉或心脏指标异常无关。就甲状旁腺激素水平区分25羟维生素D低于20 ng/mL而非30 ng/mL的患者而言，这些数据支持25羟维生素D阈值为20 ng/mL在PHPT中具有临床相关性。
