Vitamin D, Parathyroid Hormone, and Cardiovascular Events Among Older Adults

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:58

Article

Kestenbaum, Bryan¹  Katz, Ronit²  Hoofnagle, Andy³  Sarnak, Mark J.⁶  Shlipak, Michael G.⁷  Jenny, Nancy S.⁸  Siscovick, David S.^4,5 

[1] Univ Washington, Div Nephrol, Kidney Res Inst, Harborview Med Ctr, Seattle, WA 98104 USA

[2] Univ Washington, Collaborat Hlth Studies Coordinating Ctr, Dept Biostat, Seattle, WA 98104 USA

[3] Univ Washington, Dept Lab Med, Seattle, WA 98104 USA

[4] Univ Washington, Dept Med, Cardiovasc Hlth Res Unit, Seattle, WA 98104 USA

[5] Univ Washington, Dept Epidemiol, Cardiovasc Hlth Res Unit, Seattle, WA 98104 USA

[6] Tufts Univ New England Med Ctr, Dept Med, Boston, MA USA

[7] Univ Calif San Francisco, Gen Internal Med Sect, Vet Affairs Med Ctr, San Francisco, CA 94143 USA

[8] Univ Vermont, Coll Med, Dept Pathol, Colchester Res Facil, Colchester, VT USA

关键词: cardiovascular death;    heart failure;    mineral metabolism;    myocardial infarction;    parathyroid hormone;    vitamin D;   

DOI  :  10.1016/j.jacc.2011.03.069

来源: Elsevier

【 摘 要 】

Objectives The aim of this study was to evaluate associations of 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) concentrations separately and in combination with incident cardiovascular events and mortality during 14 years of follow-up in the CHS (Cardiovascular Health Study). Background Vitamin D deficiency and PTH excess are common in older adults and may adversely affect cardiovascular health. Methods A total of 2,312 participants who were free of cardiovascular disease at baseline were studied. Vitamin D and intact PTH were measured from previously frozen serum using mass spectrometry and a 2-site immunoassay. Outcomes were adjudicated cases of myocardial infarction, heart failure, cardiovascular death, and all-cause mortality. Results There were 384 participants (17%) with serum 25-OHD concentrations <15 ng/ml and 570 (25%) with serum PTH concentrations >= 65 pg/ml. After adjustment, each 10 ng/ml lower 25-OHD concentration was associated with a 9% greater (95% confidence interval [CI]: 2% to 17% greater) relative hazard of mortality and a 25% greater (95% CI: 8% to 44% greater) relative hazard of myocardial infarction. Serum 25-OHD concentrations <15 ng/ml were associated with a 29% greater (95% CI: 5% to 55% greater) risk for mortality. Serum PTH concentrations >= 65 pg/ml were associated with a 30% greater risk for heart failure (95% CI: 6% to 61% greater) but not other outcomes. There was no evidence of an interaction between serum 25-OHD and PTH concentrations and cardiovascular events. Conclusions Among older adults, 25-OHD deficiency is associated with myocardial infarction and mortality; PTH excess is associated with heart failure. Vitamin D and PTH might influence cardiovascular risk through divergent pathways. (J Am Coll Cardiol 2011;58:1433-41) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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