- 作者：Bryan ; Kestenbaum MD ; MS?/sup> ; ; brk@u.washington.edu ; Ronit ; Katz DPhil&dagger ; ; Ian ; de Boer MD ; MS?/sup> ; Andy ; Hoofnagle MD ; PhD&Dagger ; ; Mark J. ; Sarnak MD ; MS?/sup> ; Michael G. ; Shlipak MD ; MPH¶ ; ; Nancy S. ; Jenny PhD# ; David S. ; Siscovick MD ; MPH§ ;
- 关键词：cardiovascular death ; heart failure ; mineral metabolism ; myocardial infarction ; parathyroid hormone ; vitamin D
- 刊名：Journal of the American College of Cardiology
- 出版年：2011
- 出版时间：27 September 2011
- 年：2011
- 卷：58
- 期：14
- 页码：1433-1441
- 全文大小：580 K
Objectives
The aim of this study was to evaluate associations of 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) concentrations separately and in combination with incident cardiovascular events and mortality during 14 years of follow-up in the CHS (Cardiovascular Health Study).Background
Vitamin D deficiency and PTH excess are common in older adults and may adversely affect cardiovascular health.
Methods
A total of 2,312 participants who were free of cardiovascular disease at baseline were studied. Vitamin D and intact PTH were measured from previously frozen serum using mass spectrometry and a 2-site immunoassay. Outcomes were adjudicated cases of myocardial infarction, heart failure, cardiovascular death, and all-cause mortality.
Results
There were 384 participants (17 % ) with serum 25-OHD concentrations <15 ng/ml and 570 (25 % ) with serum PTH concentrations ?5 pg/ml. After adjustment, each 10 ng/ml lower 25-OHD concentration was associated with a 9 % greater (95 % confidence interval [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 for mortality. Serum PTH concentrations ?5 pg/ml were associated with a 30 % greater risk for 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.
Conclusions
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.