Plasma Parathyroid Hormone and the Risk of Cardiovascular Mortality in the Community
Abstract
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 (<6.8 pmol/L) with no other signs of a disturbed mineral metabolism (normal serum calcium, 2.2 to 2.6 mmol/L; normal glomerular filtration rate, >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.
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Cites
Wolfe, R. A., Ashby, V. B., Milford, E. L., OJO, A. O., Ettenger, R. E., Agodoa, L. Y. C., Held, P. J., & Port, F. K. (1999) · New England Journal of Medicine · doi:10.1056/nejm199912023412303 · Cited by 5,370 · see citing works
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
Block, G. A., Klassen, P., Lazarus, J. M., Ofsthun, N. J., Lowrie, E. G., & Chertow, G. M. (2004) · Journal of the American Society of Nephrology · doi:10.1097/01.asn.0000133041.27682.a2 · Cited by 2,684 · see citing works
Vitamin D Deficiency and Risk of Cardiovascular Disease
Wang, T. J., Pencina, M. J., Booth, S. L., Jacques, P. F., Ingelsson, E., Lanier, K. J., Benjamin, E. J., D’Agostino, R. B., Wolf, M. S., & Vasan, R. S. (2008) · Circulation · doi:10.1161/circulationaha.107.706127 · Cited by 2,394 · see citing works
Self-citationTunstall-Pedoe, H., Kuulasmaa, K., Amouyel, P., Arveiler, D., Rajakangas, A.-M., & Pająk, A. (1994) · Circulation · doi:10.1161/01.cir.90.1.583 · Cited by 2,260 · see citing works
Use and misuse of population attributable fractions
Rockhill, B., Newman, B., & Weinberg, C. (1998) · American Journal of Public Health · doi:10.2105/ajph.88.1.15 · Cited by 1,683 · see citing works
Pencina, M. J., & D’Agostino, R. B. (2004) · Statistics in Medicine · doi:10.1002/sim.1802 · Cited by 1,446 · see citing works
Pepe, M. S. (2004) · American Journal of Epidemiology · doi:10.1093/aje/kwh101 · Cited by 1,276 · see citing works
Dobnig, H. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.12.1340 · Cited by 1,209 · see citing works
25-Hydroxyvitamin D and Risk of Myocardial Infarction in Men A Prospective Study
Giovannucci, E. L. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.11.1174 · Cited by 1,137 · see citing works
Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism
(2018) · Wiley eBooks · doi:10.1002/9781119266594 · Cited by 1,103 · see citing works
Use of Multiple Biomarkers to Improve the Prediction of Death from Cardiovascular Causes
Zethelius, B., Berglund, L., Sundström, J., Ingelsson, E., Basu, S., Larsson, A. O., Venge, P., & Ärnlöv, J. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0707064 · Cited by 887 · see citing works
Self-citationDhingra, R. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.9.879 · Cited by 861 · see citing works
Cunningham, J., Danese, M. D., Olson, K. A., Klassen, P., & Chertow, G. M. (2005) · Kidney International · doi:10.1111/j.1523-1755.2005.00596.x · Cited by 565 · see citing works
Relationship Between Osteoporosis and Cardiovascular Disease in Postmenopausal Women
Tankó, L. B., Christiansen, C., Cox, D. A., et al. (2005) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.050711 · Cited by 546 · see citing works
Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin C values in mg/L
Larsson, A. O., Malm, J., GRUBB, A. O., et al. (2004) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365510410003723 · Cited by 407 · see citing works
Effect of parathyroid hormone on rat heart cells.
BOGIN, E., Massry, S. G., & Harary, I. (1981) · Journal of Clinical Investigation · doi:10.1172/jci110137 · Cited by 333 · see citing works
Primary hyperparathyroidism and heart disease ? a review
ANDERSSON, P., Rydberg, E., & Willenheimer, R. B. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.07.010 · Cited by 302 · see citing works
Troponin I as a Predictor of Coronary Heart Disease and Mortality in 70-Year-Old Men
Zethelius, B., Johnston, N., & Venge, P. (2006) · Circulation · doi:10.1161/circulationaha.105.570762 · Cited by 281 · see citing works
Helmersson, J., Vessby, B. O., Larsson, A. O., & Basu, S. (2004) · Circulation · doi:10.1161/01.cir.0000124718.99562.91 · Cited by 247 · see citing works
Parathyroid hormone and left ventricular hypertrophy
Saleh, F. (2003) · European Heart Journal · doi:10.1016/j.ehj.2003.09.010 · Cited by 247 · see citing works
Serum parathyroid hormone level is associated with body mass index. The 5th Tromso study
Kamycheva, E., Sundsfjord, J., & Jorde, R. (2004) · European Journal of Endocrinology · doi:10.1530/eje.0.1510167 · Cited by 212 · see citing works
A method for checking regression models in survival analysis based on the risk score
Gr�nnesby, J. K., & Borgan, Ø. (1996) · Lifetime Data Analysis · doi:10.1007/bf00127305 · Cited by 209 · see citing works
Resnick, H. E., Harris, M. I., Brock, D. B., & Harris, T. B. (2000) · Diabetes Care · doi:10.2337/diacare.23.2.176 · Cited by 201 · see citing works
Chronic continuous PTH infusion results in hypertension in normal subjects.
Hulter, H. N., Melby, J. C., Peterson, J. C., & Cooke, C. R. (1986) · PubMed · Cited by 161 · see citing works
Lind, L., Skarfors, E., Berglund, L., Lithell, H., & Ljunghall, S. (1997) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(97)00104-2 · Cited by 153 · see citing works
Self-citationSerum parathyroid hormone levels predict coronary heart disease: the Tromsø Study
Kamycheva, E., Sundsfjord, J., & Jorde, R. (2004) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000114706.27531.01 · Cited by 143 · see citing works
Rashid, G., Bernheim, J., Green, J., & Benchetrit, S. (2006) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00406.2006 · Cited by 141 · see citing works
Effect of parathyroid hormone on myocardial energy metabolism in the rat
Baczynski, R., Massry, S. G., Kohan, R., Magott, M., Saglikes, Y., & Brautbar, N. (1985) · Kidney International · doi:10.1038/ki.1985.71 · Cited by 132 · see citing works
Sambrook, P. N., Chen, J. S., March, L. M., Cameron, I. D., Cumming, R. G., Lord, S. R., Schwarz, J., & Seibel, M. J. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0307 · Cited by 132 · see citing works
Parathyroid Hormone Has a Prosclerotic Effect on Vascular Smooth Muscle Cells
Perkovic, V., Hewitson, T. D., Kelynack, K. J., et al. (2003) · Kidney & Blood Pressure Research · doi:10.1159/000069761 · Cited by 124 · see citing works
Serum parathyroid hormone as a predictor of increase in systolic blood pressure in men
Jorde, R., Svartberg, J. B., & Sundsfjord, J. (2005) · Journal of Hypertension · doi:10.1097/01.hjh.0000179764.40701.36 · Cited by 107 · see citing works
Amann, K., Törnig, J., Flechtenmacher, C., et al. (1995) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/10.11.2043 · Cited by 106 · see citing works
Byberg, L., Siegbahn, A., Berglund, L., McKeigue, P., Reneland, R., & Lithell, H. (1998) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.18.2.258 · Cited by 105 · see citing works
Self-citationPARATHYROID HORMONE HAS A POSITIVE INOTROPIC ACTION IN THE RAT
KATOH, Y., Klein, K. L., Kaplan, R. A., et al. (1981) · Endocrinology · doi:10.1210/endo-109-6-2252 · Cited by 100 · see citing works
Inference on Correlated Discrimination Measures in Survival Analysis: A Nonparametric Approach
Antolini, L., Nam, B., & D’Agostino, R. B. (2004) · Communication in Statistics- Theory and Methods · doi:10.1081/sta-200026579 · Cited by 73 · see citing works
Parathyroid adenomas and cardiovascular risk.
de la Torre, N. G., Wass, J. A. H., & Turner, H. E. (2003) · Endocrine Related Cancer · doi:10.1677/erc.0.0100309 · Cited by 73 · see citing works
Vassalotti, J. A., Uribarri, J., Chen, S., et al. (2008) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2007.12.018 · Cited by 71 · see citing works
Øgard, C. G., Engelmann, M. D. M., Kistorp, C., Nielsen, S. L., & Vestergaard, H. (2005) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02363.x · Cited by 63 · see citing works
Regulation of protein synthesis and degradation in adult ventricular cardiomyocytes
Schlüter, K. ‐., Millar, B. C., McDermott, B. J., et al. (1995) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.1995.269.6.c1347 · Cited by 55 · see citing works
Fisher, A. A., Southcott, E., Srikusalanukul, W., Davis, M. W., Hickman, P. E., Potter, J. M., & Smith, P. N. (2007) · PubMed · Cited by 36 · see citing works
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Ford, J. A., MacLennan, G. S., Avenell, A., Bolland, M., Grey, A., & Witham, M. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.082602 · Cited by 268 · see citing works
Pilz, S., Kienreich, K., Drechsler, C., Ritz, E., Fahrleitner-Pammer, A., Gaksch, M., Meinitzer, A., März, W., Pieber, T. R., & Tomaschitz, A. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2183 · Cited by 118 · see citing works
Deo, R., Katz, R., Shlipak, M. G., Sotoodehnia, N., Psaty, B. M., Sarnak, M. J., Fried, L. F., Chonchol, M., de Boer, I. H., Enquobahrie, D., et al. (2011) · Hypertension · doi:10.1161/hypertensionaha.111.179135 · Cited by 107 · see citing works
Beysel, S., Caliskan, M., Kizilgul, M., Apaydin, M., Kan, S., Ozbek, M., & Cakal, E. (2019) · BMC Cardiovascular Disorders · doi:10.1186/s12872-019-1093-4 · Cited by 95 · see citing works
Vaidya, A., Forman, J. P., Hopkins, P. N., Seely, E. W., & Williams, J. S. (2011) · Journal of the Renin-Angiotensin-Aldosterone System · doi:10.1177/1470320310391922 · Cited by 93 · see citing works
Brown, J. M., Williams, J. S., Luther, J. M., Garg, R., Garza, A. E., Pojoga, L. H., Ruan, D. T., Williams, G. H., Adler, G. K., & Vaidya, A. (2014) · Hypertension · doi:10.1161/hypertensionaha.113.01910 · Cited by 88 · see citing works
Serum Parathyroid Hormone in Relation to All-Cause and Cardiovascular Mortality: The Hoorn Study
van Ballegooijen, A. J., Reinders, I., Visser, M., Dekker, J. M., Nijpels, G., Stehouwer, C. D. A., Pilz, S., & Brouwer, I. A. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-4007 · Cited by 62 · see citing works
Gambardella, J., De Rosa, M., Sorriento, D., Prevete, N., Fiordelisi, A., Ciccarelli, M., Trimarco, B., De Luca, N., & Iaccarino, G. (2018) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2018/9582319 · Cited by 58 · see citing works
Interactions between adrenal-regulatory and calcium-regulatory hormones in human health
Brown, J. M., & Vaidya, A. (2014) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000062 · Cited by 39 · see citing works
Fischer, E., Hannemann, A., Rettig, R., Lieb, W., Nauck, M., Pallauf, A., Bildingmaier, M., Beuschlein, F., Wallaschofski, H., & Reincke, M. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3214 · Cited by 37 · see citing works
Wetzel, J., Pilz, S., Grübler, M. R., Fahrleitner‐Pammer, A., Dimai, H. P., von Lewinski, D., Kolesnik, E., Perl, S., Trummer, C., Schwetz, V., et al. (2017) · The Journal of Clinical Hypertension · doi:10.1111/jch.13064 · Cited by 22 · see citing works
Volk, C., Schmidt, B., Brandsch, C., Kurze, T., Schlegelmilch, U., Grosse, I., Ulrich, C., Girndt, M., & Stangl, G. I. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab635 · Cited by 21 · see citing works
- Authors
- Hagström, E., Hellman, P., Larsson, T. E., Ingelsson, E., Berglund, L., Sundström, J., Melhus, H., Held, C., Lind, L., Michaëlsson, K., & Ärnlöv, J.
- Affiliations
- From Uppsala Clinical Research Center (E.H., L.B., C.H., K.M.), Department of Surgical Sciences, (E.H., P.H., K.M.), Department of Public Health and Caring Sciences/Geriatrics (E.I., J.Ä.), and Department of Medical Sciences (T.E.L., J.S., H.M., L.L.), Uppsala University, Uppsala; Departments of Medical Epidemiology and Biostatistics (E.I) and Nephrology (T.E.L.), Karolinska Institutet, Stockholm; and the Department of Health and Social Sciences (J.Ä.), Högskolan Dalarna, Falun, Sweden.
- Uppsala University (SE)
- Venue
- Circulation
- Published
- 2009-06-02
- Volume
- 119
- Issue
- 21
- Pages
- 2765-2771
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2140849426
- Cited by
- 416
- References
- 40
- Citations by year
- 2026: 14 · 2025: 12 · 2024: 12 · 2023: 10 · 2022: 10 · 2021: 14 · 2020: 18 · 2019: 12 · 2018: 13 · 2017: 28 · 2016: 26 · 2015: 27 · 2014: 37 · 2013: 42 · 2012: 47
- FWCI
- 32.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Vitamin D Research Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- parathyroid hormone, cardiovascular mortality, hyperparathyroidism, cardiovascular risk prediction, older men, population attributable risk, cardiovascular risk factors
- MeSH terms
- Aged, Aged, 80 and over, Blood Glucose, C-Reactive Protein, Calcium, Calcium, Dietary, Cardiovascular Diseases, Diabetes Mellitus, Follow-Up Studies, Glomerular Filtration Rate, Humans, Hyperparathyroidism, Male, Middle Aged, Mortality, Parathyroid Hormone, Peptide Fragments, Phosphates, Risk, Sweden, Vitamin D, Comorbidity, Proportional Hazards Models, Troponin I, Natriuretic Peptide, Brain, Cystatin C
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