Plasma Parathyroid Hormone and the Risk of Cardiovascular Mortality in the Community
Plasma Parathyroid Hormone and the Risk of Cardiovascular Mortality in the Community
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DOI：
10.1161/circulationaha.108.808733
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发表时间：
2009-06-02
期刊：
影响因子：
37.8
通讯作者：
Arnlov, Johan
中科院分区：
文献类型：
--
作者：
Hagstrom, Emil;Hellman, Per;Arnlov, Johan
背景-甲状旁腺激素(PTH)水平升高的疾病，如原发性和继发性甲状旁腺功能亢进症，与心血管疾病和死亡的发生率增加有关。方法与结果：采用Uppsala成人男性纵向研究(ULSAM)，一个以社区为基础的老年男性队列(平均年龄71岁；n=958)，调查了血浆PTH与心血管死亡率之间的关系。在随访期间(中位数为9.7年)，117名参与者死于心血管疾病。在校正了已建立的心血管危险因素(年龄、收缩压、糖尿病、吸烟、体重指数、总胆固醇、高密度脂蛋白胆固醇、降压治疗、降脂治疗和心血管病史)的COX比例风险模型中，较高的血浆甲状旁腺素与较高的心血管死亡风险相关(甲状旁腺素1-SD增加的危险比为1.38；95%可信区间为1.18至1.6；P<；0.001)。在没有心血管疾病的参与者和PTH正常的参与者(50毫升)中，这种关联基本上没有改变。分钟(-1)。1.73m(-2)且无维生素D缺乏，血浆25-羟基维生素D和谷草转氨酶；37.5nmol/L)。有趣的是，血浆甲状旁腺素升高(>；5.27pmol/L)占心血管死亡人群归因危险比例的20%(95%可信区间，10至26)。结论-血浆甲状旁腺素水平预测社区心血管死亡，即使在正常范围内甲状旁腺素水平的个体。有必要进一步研究以评估甲状旁腺素在心血管危险预测中的临床意义，并阐明甲状旁腺素是否是一个可改变的危险因素。(发行量。2009年；119：2765-2771。)
Background-Diseases with elevated levels of parathyroid hormone (PTH) such as primary and secondary hyperparathyroidism are associated with increased incidence of cardiovascular disease and death. However, data on the prospective association between circulating PTH levels and cardiovascular mortality in the community are lacking.Methods and Results-The Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men (mean age, 71 years; n = 958), was used to investigate the association between plasma PTH and cardiovascular mortality. During follow-up (median, 9.7 years), 117 participants died of cardiovascular causes. In Cox proportional-hazards models adjusted for established cardiovascular risk factors (age, systolic blood pressure, diabetes, smoking, body mass index, total cholesterol, high-density lipoprotein cholesterol, antihypertensive treatment, lipid-lowering treatment, and history of cardiovascular disease), higher plasma PTH was associated with higher risk for cardiovascular mortality (hazard ratio for 1-SD increase in PTH, 1.38; 95% confidence interval, 1.18 to 1.60; P < 0.001). This association remained essentially unaltered in participants without previous cardiovascular disease and in participants with normal PTH (50 mL . min(-1) . 1.73 m(-2) and without vitamin D deficiency, plasma 25-OH vitamin D >37.5 nmol/L). Interestingly, elevated plasma PTH (>5.27 pmol/L) accounted for 20% (95% confidence interval, 10 to 26) of the population-attributable risk proportion for cardiovascular mortality.Conclusions-Plasma PTH levels predict cardiovascular mortality in the community, even in individuals with PTH within the normal range. Further studies are warranted to evaluate the clinical implications of measuring PTH in cardiovascular risk prediction and to elucidate whether PTH is a modifiable risk factor. (Circulation. 2009; 119: 2765-2771.)