Bansal Nisha, Zelnick Leila, Robinson-Cohen Cassianne, Hoofnagle Andy N, Ix Joachim H, Lima Joao A, Shoben Abigail B, Peralta Carmen A, Siscovick David S, Kestenbaum Bryan, de Boer Ian H
Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.).
University of California, San Diego, CA (J.H.I.).
J Am Heart Assoc. 2014 Dec 2;3(6):e001278. doi: 10.1161/JAHA.114.001278.
Heart failure (HF) is common and is associated with high mortality. We aimed to determine associations of serum parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) with incident HF and left ventricular mass.
Among 6459 participants in the community-based Multi-Ethnic Study of Atherosclerosis, all of whom were free of prevalent clinical cardiovascular disease, we measured serum concentrations of PTH and 25(OH)D at the baseline examination. In longitudinal analyses, we tested associations of PTH and 25(OH)D with incident HF events, adjudicated by a panel of physicians. In cross-sectional analyses of a subset of 4763 participants, we tested associations of PTH and 25(OH)D with left ventricular mass, measured by cardiac magnetic resonance imaging at baseline. Multivariable Cox proportional hazard and linear regression models were adjusted for demographics, physical examination measures, comorbidity, kidney function, and other mineral metabolism markers. Mean age was 62 years and 53% of participants were female. There were 180 incident HF events over a median (interquartile range) follow-up time of 8.46 (7.67 to 8.63) years. Compared with participants with PTH <65 pg/mL, PTH ≥65 pg/mL was associated with a 50% greater risk of incident HF (95% CI: 3% to 210%) and a 5.3 g higher left ventricular mass (95% CI: 2.6, 7.9 g). In contrast, there was no association of 25(OH)D with risk of incident HF or elevated left ventricular mass.
In a racially/ethnically diverse population without prevalent cardiovascular disease, higher serum PTH concentration was associated with increased left ventricular mass and increased risk of incident HF. Further studies should be pursued to determine whether PTH excess may be a modifiable risk factor for HF.
心力衰竭（HF）很常见，且与高死亡率相关。我们旨在确定血清甲状旁腺激素（PTH）和25-羟基维生素D（25[OH]D）与新发HF及左心室质量之间的关联。
在基于社区的动脉粥样硬化多民族研究的6459名参与者中，所有参与者均无临床心血管疾病史，我们在基线检查时测量了血清PTH和25(OH)D浓度。在纵向分析中，我们测试了PTH和25(OH)D与新发HF事件之间的关联，该事件由一组医生判定。在对4763名参与者的子集进行的横断面分析中，我们测试了PTH和25(OH)D与左心室质量之间的关联，左心室质量在基线时通过心脏磁共振成像测量。多变量Cox比例风险模型和线性回归模型对人口统计学、体格检查指标、合并症、肾功能和其他矿物质代谢标志物进行了校正。平均年龄为62岁，53%的参与者为女性。在中位（四分位间距）随访时间8.46（7.67至8.63）年期间，有180例新发HF事件。与PTH<65 pg/mL的参与者相比，PTH≥65 pg/mL与新发HF风险高50%（95%CI：3%至210%）以及左心室质量高5.3 g（95%CI：2.6，7.9 g）相关。相比之下，25(OH)D与新发HF风险或左心室质量升高无关。
在无心血管疾病史的种族/民族多样化人群中，较高的血清PTH浓度与左心室质量增加和新发HF风险增加相关。应进一步开展研究以确定PTH过量是否可能是HF的一个可改变的风险因素。
