Parathyroid hormone and vitamin D-markers for cardiovascular and all cause mortality in heart failure

• Published in: European journal of heart failure 2011-06, Vol.13 (6), p.626-632
• Main Authors: Schierbeck, Louise Lind, Jensen, Torben Slott, Bang, Ulrich, Jensen, Gorm, Køber, Lars, Jensen, Jens-Erik Beck
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Cause of Death; Cross-Sectional Studies; Female; Follow-Up Studies; Heart failure; Heart Failure - blood; Heart Failure - mortality; Humans; Male; Middle Aged; Mortality; Parathyroid hormone; Parathyroid Hormone - blood; Prognosis; Prospective Studies; Vitamin D; Vitamin D - analogs & derivatives; Vitamin D - blood
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfr016

Aims To investigate levels of vitamin D and parathyroid hormone (PTH) in a population of heart failure (HF) patients, and to evaluate whether vitamin D and PTH are related to prognosis. Methods and results This was a prospective study of 148 HF outpatients (mean age 68 years, 102 men) with follow‐up for mortality after 3½ years. Levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), PTH, 25‐hydroxyvitamin D (25‐OHD), and several other biomarkers were examined. Mortality and cardiovascular mortality were analysed in multivariable regression analyses adjusting for other independent prognostic variables. Vitamin D deficiency (≤50 nmol/L) was prevalent in 43% of the population; 26% had elevated PTH levels; none had primary hyperparathyroidism. We found a strong and independent significant association of both PTH and vitamin D to mortality, which was independent of other clinically important parameters [NT‐proBNP, estimated glomerular filtration rate (eGFR), age, and left ventricular ejection fraction (LVEF)]. Both PTH and vitamin D were also significantly associated with all cause mortality. In an adjusted model, we found a hazard ratio of 1.9 (confidence interval 1.1–3.4) for vitamin D deficiency and 2.0 (1.0–3.8) for the upper median of PTH, respectively. Conclusion In this relatively small prospective study, PTH and vitamin D were independently associated with all cause and cardiovascular mortality in patients with HF. This was independent of other known risk factors such as eGFR, LVEF, NT‐proBNP, and age.