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Cited by 27Hormonal Regulation and HypertensionParathyroid Disorders and TreatmentsRenin-Angiotensin System Studies

Interrelated aldosterone and parathyroid hormone mutually modify cardiovascular mortality risk

Tomaschitz, Andreas, Pilz, Stefan, Rus-Machan, Jutta, Meinitzer, Andreas, Brandenburg, Vincent M., Scharnagl, Hubert, Kapl, Martin, Grammer, Tanja +11 more·2015·International Journal of Cardiology
DOI 10.1016/j.ijcard.2015.03.062
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Abstract

Background Inappropriate aldosterone and parathyroid hormone (PTH) secretion is associated with increased cardiovascular risk. Accumulating evidence suggests bidirectional interplay between aldosterone and PTH.Methods We evaluated the cross-sectional relationship between plasma aldosterone concentration (PAC), aldosterone to renin ratio (ARR) and PTH and subsequently tested whether the interaction between PAC and PTH modified the risk of cardiovascular death. PAC [78.0 (48.0-123.0) pg/mL], ARR [6.4 (2.9-12.9) pg/mL/pg/mL] and PTH concentration [median: 29.0 (22.0-40.0) pg/mL] were measured in 3074 patients (mean age: 62.5 ± 10.6 years; 30.3% women) referred to coronary angiography in a tertiary care center in Southwest Germany.Results Using multiple linear regression analysis, PAC and ARR emerged as an independent predictor of higher PTH concentrations (β=0.12 and 0.21, P<0.001 for both) irrespective of intake of antihypertensive treatment, 25(OH)D, kidney function, serum calcium, phosphate, magnesium, cortisol, NT-pro-BNP, soluble α-klotho and FGF-23 concentration. After a median follow-up of 9.9 years, 512 (16.7%) participants had died due to fatal cardiovascular events. Multivariate Cox proportional hazard analysis revealed that both PAC and PTH were independently associated with cardiovascular mortality, with a potential synergistic interaction (P=0.028). PAC and PTH are exclusively associated with cardiovascular death in subjects with PTH and PAC concentrations above the median, respectively (PAC: HR per log SD: 1.14; 95% CI 1.02-1.29; P=0.026; PTH: HR per log SD: 1.18; 95% CI 1.02-1.37; P=0.031).Conclusions Higher PAC and ARR were independently associated with PTH. PAC was independently related to incident cardiovascular mortality exclusively in patients with elevated PTH and vice versa.

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Authors
Tomaschitz, A., Pilz, S., Rus-Machan, J., Meinitzer, A., Brandenburg, V. M., Scharnagl, H., Kapl, M., Grammer, T., Ritz, E., Horina, J. H., Kleber, M. E., Pieske, B., Kraigher-Krainer, E., Hartaigh, B. Ó., Toplak, H., van Ballegooijen, A. J., Amrein, K., Fahrleitner-Pammer, A., & März, W.
Affiliations
  • Medical University of Graz (AT)
  • Universitätsklinikum Aachen (DE)
  • Heidelberg University (DE)
  • University Hospital Heidelberg (DE)
  • NewYork–Presbyterian Hospital (US)
Corresponding author
  • Tomaschitz, Andreas
  • Pilz, Stefan
ORCID
Venue
International Journal of Cardiology
Publisher
Elsevier BV
Published
2015-04
Volume
184
Pages
710-716
ISSN
0167-5273 (ISSN-L)
DOI
10.1016/j.ijcard.2015.03.062
OpenAlex
W2146014069
Cited by
27
References
38
Citations by year
2025: 1 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 5 · 2019: 1 · 2018: 3 · 2017: 4 · 2016: 4 · 2015: 2
FWCI
3.76
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • International Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • VU Research Portal (publishedVersion)
  • RWTH Publications (RWTH Aachen) (submittedVersion)
  • VU Research Portal (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • 6th Framework Program (LSHM-CT-2004-503485)
  • 7th Framework Program (201668)
  • RiskyCAD (305739)
  • European Union, by the INTERREG IV Oberrhein Program
  • European Regional Development Fund
  • Wissenschaftsoffensive TMO
  • German Ministry for Education and Research (01ZX1313A-K)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Keywords
aldosterone, parathyroid hormone, cardiovascular mortality, aldosterone-renin ratio, plasma aldosterone, coronary artery disease, mineral metabolism, synergistic interaction
MeSH terms
Fibroblast Growth Factor-23, Aged, Aldosterone, Cardiovascular Diseases, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Parathyroid Hormone, Risk Factors, Biomarkers

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