Plasma parathyroid hormone and risk of congestive heart failure in the community

• Published in: European journal of heart failure Vol. 12; no. 11; pp. 1186 - 1192
• Main Authors: Hagström, Emil, Ingelsson, Erik, Sundström, Johan, Hellman, Per, Larsson, Tobias E., Berglund, Lars, Melhus, Håkan, Held, Claes, Michaëlsson, Karl, Lind, Lars, Ärnlöv, Johan
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2010
• Subjects: Aged; community; Health and Welfare; heart failure; Heart Failure - blood; Heart Failure - epidemiology; Heart Failure - physiopathology; Hospitalization - statistics & numerical data; Humans; Hälsa och välfärd; Kirurgi; Kirurgisk forskning; Male; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Orthopaedics; Ortopedi; Parathyroid hormone; Parathyroid Hormone - blood; Parathyroid Hormone - physiology; prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Surgery; Surgical research
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1093/eurjhf/hfq134

Aims 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. Methods and Results 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. Conclusion 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.