Vitamin D, parathyroid hormone, and cardiovascular events among older adults.
Vitamin D, parathyroid hormone, and cardiovascular events among older adults.
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DOI：
10.1016/j.jacc.2011.03.069
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发表时间：
2011-09-27
影响因子：
24
通讯作者：
Siscovick, David S.
中科院分区：
文献类型：
--
作者：
Kestenbaum, Bryan;Katz, Ronit;de Boer, Ian;Hoofnagle, Andy;Sarnak, Mark J.;Shlipak, Michael G.;Jenny, Nancy S.;Siscovick, David S.
关键词：
维生素 D 缺乏和甲状旁腺激素 (PTH) 过量在老年人中很常见，可能会对心血管健康产生不利影响。我们在心血管健康研究的 14 年随访期间分别和联合评估了 25-羟基维生素 D (25-OHD) 和 PTH 浓度与心血管事件和死亡率之间的关联。我们研究了 2,312 名基线时没有心血管疾病的参与者。我们使用质谱法和双位点免疫测定法测量了先前冷冻血清中的 25-OHD 和完整 PTH。结果是判定心肌梗塞、心力衰竭、心血管死亡和全因死亡病例。有 384 名参与者 (17%) 的血清 25-OHD 浓度 <15 ng/ml，570 名参与者 (25%) 的血清 PTH 浓度≥ 65 pg/ml。调整后，25-OHD 浓度每降低 10 ng/ml，死亡相对风险增加 9%（95% CI 增加 2% 至 17%），心肌梗死相对危险增加 25%（95% CI 增加 8% 至 44%）。血清 25-OHD 浓度<15 ng/ml 与死亡风险增加 29%（95% CI 增加 5% 至 55%）相关。血清 PTH 浓度≥ 65 pg/ml 与心力衰竭风险增加 30% 相关（95% CI 增加 6% 至 61%），但与其他结果无关。没有证据表明血清 25-OHD 和 PTH 浓度与心血管事件之间存在相互作用。在老年人中，25-OHD 缺乏与心肌梗塞和死亡率相关； PTH 过多与心力衰竭有关。维生素 D 和 PTH 可能通过不同的途径影响心血管风险。
Vitamin D deficiency and parathyroid hormone (PTH) excess are common among older adults and may adversely impact cardiovascular health. We evaluated associations of 25-hydroxyvitamin D (25-OHD) and PTH concentrations, separately, and in combination, with incident cardiovascular events and mortality during 14 years of follow-up in the Cardiovascular Health Study. We studied 2,312 participants who were free of cardiovascular disease at baseline. We measured 25-OHD and intact PTH from previously frozen serum using mass spectrometry and a two-site immunoassay. Outcomes were adjudicated cases of myocardial infarction, heart failure, cardiovascular death, and all cause mortality. There were 384 participants (17%) who had serum 25-OHD concentrations <15 ng/ml and 570 (25%) who had serum PTH concentrations ≥ 65 pg/ml. After adjustment, each 10-ng/ml lower 25-OHD concentration was associated with a 9% greater (95% 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 of mortality. Serum PTH concentrations ≥ 65 pg/ml were associated with a 30% greater risk of 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. 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.
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