Study of Parathyroid Hormone as an Independent Risk Marker of Heart Failure

ABSTRACT Introduction Heart failure (HF) is a clinical syndrome characterized by cardiac pump failure with signs and symptoms arising from salt and water retention. Heart failure is associated with considerable mortality and morbidity. Identification of modifiable risk factors may reduce incidence of HF and its complications. The aim of our study is to assess parathyroid hormone (PTH) as a risk marker for HF and its association with severity of HF. Materials and methods In this cross-sectional study, 120 subjects with HF were recruited and they were compared with 60 age- and sex-matched controls. Along with the routine parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP), intact PTH, and vitamin D were estimated. The study group was divided into quartiles depending on PTH value. Results The median PTH (81.5 pg/mL) and NT-proBNP (3753 pg/mL) in HF patients are found to be significantly higher (p < 0.0001) when compared with control subjects. The median vitamin D concentration (18 ng/mL) though low in cases is not statistically significant when compared with controls. Demographic, clinical, and laboratory characteristics are compared across the quartiles of PTH. Highest number of New York Heart Association (NYHA) class IV HF cases are found in highest quartiles of PTH. Logistic regression analysis demonstrated that high concentration of PTH [odds ratio of 1.1113; 95% confidence interval (CI) 1.07—1.14; p < 0.0001] and low levels of vitamin D (odds ratio of 1.053; 95% CI 1.0079—1.1009) are significantly associated with HF. Conclusion This study has demonstrated that higher concentration of PTH is associated with severe form of HF. Vitamin D deficiency is also seen in the study group. How to cite this article Khan SA, Iyyapu KM, Sai Baba KSS, Yerram S. Study of Parathyroid Hormone as an Independent Risk Marker of Heart Failure. Indian J Med Biochem 2017;21(2):157-161.

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Faculty Opinions recommendation of Parathyroid hormone and vitamin D--markers for cardiovascular and all cause mortality in heart failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11767956.12859054 ◽

2011 ◽

Author(s):

Gad Cotter ◽

Olga Milo

Keyword(s):

Heart Failure ◽

Vitamin D ◽

Parathyroid Hormone ◽

All Cause Mortality

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Parathyroid Hormone in Pregnancy: Vitamin D and Other Determinants

Nutrients ◽

10.3390/nu13020360 ◽

2021 ◽

Vol 13 (2) ◽

pp. 360

Author(s):

Ola Hysaj ◽

Patricia Marqués-Gallego ◽

Aline Richard ◽

Magdeldin Elgizouli ◽

Alexandra Nieters ◽

...

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Inflection Point ◽

Demographic Data ◽

Late Pregnancy ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

25 Hydroxy Vitamin D ◽

Maximal Suppression

We aimed to assess the parathyroid hormone (PTH) concentration in pregnant women at the beginning of pregnancy (1st trimester) and within days before delivery (3rd trimester) and evaluate its determinants. From September 2014 through December 2015 in a cross-sectional study, 204 women in the 1st trimester of pregnancy and 203 women in the 3rd trimester of pregnancy were recruited. Blood samples were collected to measure PTH and circulating 25-hydroxy-vitamin D (25(OH)D) concentrations. Lifestyle and demographic data were collected using a questionnaire. Serum 25(OH)D and PTH were inversely correlated in both early and late pregnancy. Our analyses suggest that in the 3rd trimester of pregnancy, a 25(OH)D level of 18.9 ng/mL (47.3 nmol/L) could serve as an inflection point for the maximal suppression of PTH. Statistically significant determinants of PTH concentrations in multiple regression were 25(OH)D concentrations, season, multiparity and education of the partner (all p < 0.05) in early pregnancy. In late pregnancy, 25(OH)D concentrations and country of origin were statistically significant determinants of PTH concentrations (all p < 0.05). These factors and their effect on PTH appear to be vastly determined by 25(OH)D; however, they might also affect PTH through other mechanisms besides 25(OH)D.

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Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude

Nutrients ◽

10.3390/nu10070916 ◽

2018 ◽

Vol 10 (7) ◽

pp. 916 ◽

Cited By ~ 3

Author(s):

Andrea Hemmingway ◽

Karen O’Callaghan ◽

Áine Hennessy ◽

George Hull ◽

Kevin Cashman ◽

...

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Pregnant Women ◽

Calcium Intake ◽

Geometric Mean ◽

Vitamin D Status ◽

Metabolic System ◽

Cross Sectional ◽

The Mean ◽

In Pregnancy

Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks’ gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 μg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = −0.311, p < 0.001), but not with calcium intake or serum calcium (r = −0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800–1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.

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Differences in vitamin D status and calcium metabolism in Saudi Arabian boys and girls aged 6 to 18 years: effects of age, gender, extent of veiling and physical activity with concomitant implications for bone health

Public Health Nutrition ◽

10.1017/s1368980011003612 ◽

2012 ◽

Vol 15 (10) ◽

pp. 1845-1853 ◽

Cited By ~ 16

Author(s):

Maryam A Al-Ghamdi ◽

Susan A Lanham-New ◽

Jalal A Kahn

Keyword(s):

Physical Activity ◽

Vitamin D ◽

Saudi Arabia ◽

Parathyroid Hormone ◽

Bone Health ◽

Age Groups ◽

Hypovitaminosis D ◽

Vitamin D Status ◽

Kingdom Of Saudi Arabia ◽

Cross Sectional

AbstractObjectiveFew data exist looking at vitamin D status and bone health in school-aged boys and girls from Saudi Arabia. The present study aimed to determine the extent of poor vitamin D status in school boys and girls aged 6–18 years and to examine if there was any difference in status with age, physical activity and veiling and concomitant effects on bone.DesignCross-sectional study.SettingJeddah, Kingdom of Saudi Arabia.SubjectsA total of 150 boys (7–16 years) and 150 girls (6–18 years) from local schools were divided into age categories: 6–9 years (elementary school); 10–12 years (secondary school); 13–14 years (middle years); 15–18 years (high school).ResultsVitamin D status was significantly lower in girls than boys in all age groups (P < 0·01), with the 15–18-year-old girls having the lowest level (22·0 (sd 9·4) nmol/l) in comparison to the 15–18-year-old boys (39·3 (sd 14·0) nmol/l) and the 6–9-year-old girls (41·2 (sd 9·3) nmol/l). Parathyroid hormone status was highest in the 15–18-year-old girls in comparison to boys of the same age. A total of 64 % of 15–18-year-old girls had 25-hydroxyvitamin D (25OHD) status <25 nmol/l in comparison to 31 % in the 13–14 years age category, 26 % in the 10–12 years category and 2·5 % in the 6–9 years category. No boys had 25OHD status <25 nmol/l. Fully veiled girls had lower 25OHD status than partly veiled or unveiled girls (P < 0·05). Low 25OHD and high parathyroid hormone was associated with lower bone mass in the 6–9 years and 13–14 years age groups (P < 0·05).ConclusionsThese data suggest significant hypovitaminosis D in older adolescent females, which is a cause for concern given that there is currently no public health policy for vitamin D in the Kingdom of Saudi Arabia.

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Study on Heart Failure Patients Admitted in National Institute of Cardiovascular Diseases

Cardiovascular Journal ◽

10.3329/cardio.v13i2.52971 ◽

2021 ◽

Vol 13 (2) ◽

pp. 172-176

Author(s):

Nur Alam ◽

Abdullah Al Shafi Majumder

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Heart Disease ◽

Cardiovascular Diseases ◽

Epidemiological Studies ◽

Clinical Syndrome ◽

Cross Sectional ◽

Common Cause ◽

Heart Failure Patients ◽

Coronary Syndrome

Background: Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. There is a paucity of data on characteristics of the patients of heart failure admitted in hospitals in terms of demographic and etiological information. So, this study aimed to see the disease burden of heart failure patients and the age and sex specific prevalence of heart failure among patients admitted into NICVD and to identify the etiological pattern of diseases leading to heart failure with associated comorbid factors. Methods: It was a cross sectional study carried out at National Institute of Cardiovascular Diseases (NICVD) Dhaka Bangladesh and was conducted from January 2015 to December 2015. Total 400 heart failure patients were taken. Results: The mean age of the patients were 54 ± 14 years ranging from 16 to 95 years with a high preponderance of male. Most the patient population was in the age group of 51- 60 years (29.5%). 79% of the cases were male & 21% female by gender specification. Ischaemic cardiomyopathy (ICM) was found to be the common cause of heart failure (n=153, 40.75%) followed by Acute coronary syndrome (32.5%) and Valvular heart disease (18.25%). The patients with heart failure having acute coronary syndrome (n=107) had hypertension (46.8%) as the most prevalent major risk factor. In the present study only 11% patient had heart failure with preserved ejection fraction. Mortality rate of the study population were 6.3%. Conclusion: In this study, the most common cause of heart failure is ischaemic heart disease. So, patients of acute and chronic ischemic heart disease patients should be treated and follow up with care. Clinical and epidemiological studies are needed to explore further. Cardiovasc. j. 2021; 13(2): 172-176

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Abstract 6: Vitamin D3 Repletion Improves Heart Failure Patient Quality of Life and Neurohormonal Indices

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.6 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Heidi Moretti ◽

Bradley Berry ◽

Vince Colucci

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Vitamin D ◽

Vitamin D3 ◽

Nyha Class ◽

Heart Failure Patients ◽

Hydroxyvitamin D ◽

Cardiopulmonary Exercise ◽

25 Hydroxyvitamin D

Background: Vitamin D deficiency has been associated with cardiovascular mortality and sudden cardiac death in heart failure patients. Vitamin D may influence parathyroid hormone, the renin-angiotensin axis, natriuretic peptide gene expression, cardiac contractility, and cardiopulmonary function. Heart Failure (HF) studies using vitamin D to date have typically not used adequate repletion doses. Objectives: The primary objectives of this research were to determine if vitamin D repletion over a six month period in New York Heart Association (NYHA) Class II-III HF patients would result in a change in neurohormonal markers, cardiopulmonary exercise parameters, circulating 25- hydroxyvitamin D, and quality of life. Methods: A randomized, double-blinded, placebo-controlled trial assessing adjunctive Vitamin D3 supplementation in the treatment of NYHA Class II-III HF patients was conducted. Patients received 10,000 International Units (IU) per day of vitamin D3 or placebo for 6 months. Inclusion Criteria: 1) 25-hydroxyvitamin D level ≤32 ng/ml 2) stable medical regimen for 3 months. Exclusion Criteria: 1) any clinically unstable medical disorder 2) supplementation of vitamin D3 or D2 of greater than or equal to 2,000 IU/day. Study endpoints were: 1) B-type Natriuretic Peptide (BNP), 2) cardiopulmonary exercise parameters using Shape HF, 3) 25-hydroxyvitamin D, 4) intact parathyroid hormone (PTH), and 5) quality of life with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Statistical analysis included independent samples t-test and multivariate regression. Results: A total of 34 patients completed the study. When adjusted for baseline 25-hydroxyvitamin D, the difference between groups for BNP was significant ([[Unable to Display Character: ∆]]540 ±1928 pg/ml placebo vs [[Unable to Display Character: ∆]] 35 pg/ml ±1054 pg/ml treatment p=0.009). 25-hydroxyvitamin D was [[Unable to Display Character: ∆]]48.9 ±32 ng/ml treatment vs [[Unable to Display Character: ∆]]3.6 ± 9.4 ng/ml placebo, p<0.001 (mean 68 ng/ml treatment vs 23 ng/ml placebo). No toxicity was observed with treatment. PTH and exercise chronotropic response index trended towards improvement in the treatment group vs placebo group, respectively (([[Unable to Display Character: ∆]]-20 ±20 pg/ml vs [[Unable to Display Character: ∆]]7 ±54pg/ml (p=0.06)) and ([[Unable to Display Character: ∆]]0.13±0.26 versus [[Unable to Display Character: ∆]]-0.03 ± 0.23, p=0.12)). KCCQ quality of life total symptom ([[Unable to Display Character: ∆]]16 ±16 treatment vs [[Unable to Display Character: ∆]]-12 ±15 placebo, p< 0.001) and individual scores significantly improved from baseline in the treatment group. Conclusions: Preliminary results show that vitamin D3 treatment of 10,000 IU/day in heart failure patients is safe, results in adequate circulating 25-hydroxyvitamin D levels, and achieves improvement in surrogate endpoint markers of HF outcomes.

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A Cross-Sectional Study of Hyponatremia Associated with Acute Central Nervous System Infections

Journal of Clinical Medicine ◽

10.3390/jcm8111801 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1801

Author(s):

Andy K.H. Lim ◽

Sahira Paramaswaran ◽

Lucy J. Jellie ◽

Ralph K. Junckerstorff

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Odds Ratio ◽

Cross Sectional Study ◽

Clinical Syndrome ◽

Cns Infection ◽

Sectional Study ◽

Cerebrospinal Fluid Analysis ◽

Cross Sectional ◽

Fluid Analysis

Hyponatremia can occur with central nervous system (CNS) infections, but the frequency and severity may depend on the organism and nature of CNS involvement. In this cross-sectional study at a large Australian hospital network from 2015 to 2018, we aimed to determine the prevalence and severity of hyponatremia associated with CNS infection clinical syndromes, and the association with specific organisms. We examined the results of cerebrospinal fluid analysis from lumbar punctures performed in 184 adult patients with a serum sodium below 135 mmol/L who had abnormal cerebrospinal fluid analysis and a clinical syndrome consistent with an acute CNS infection (meningitis or encephalitis). Hyponatremia affected 39% of patients and was more severe and frequent in patients with encephalitis compared to meningitis (odds ratio = 3.03, 95% CI: 1.43–6.39, after adjusting for age). Hyponatremia was present on admission in 85% of cases. Herpes simplex virus infection was associated with the highest odds of hyponatremia (odds ratio = 3.25, 95% CI: 1.13–7.87) while enterovirus infection was associated with the lowest (odds ratio = 0.36, 95% CI: 0.14–0.92), compared to cases without an isolated organism. We concluded that the risk of hyponatremia may vary by the organism isolated but the clinical syndrome was a useful surrogate for predicting the probability of developing hyponatremia.

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Caregiver burden of patients with heart failure with a left-ventricular ejection fraction (LVEF) less than or equal to 60%: a cross-sectional survey in the EU

European Heart Journal ◽

10.1093/ehjci/ehaa946.0978 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Lahoz ◽

S Corda ◽

C Proudfoot ◽

A.F Fonseca ◽

S Cotton ◽

...

Keyword(s):

Heart Failure ◽

Caregiver Burden ◽

Nyha Class ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Funding Source ◽

Cross Sectional Survey ◽

Private Company ◽

Cross Sectional ◽

Patients With Heart Failure

Abstract Background and purpose The majority of patients with heart failure (HF) have difficulties in independently carrying out activities of daily living and hence, require support from caregivers (CGs). This study assessed the quality of life (QoL) of CGs of HF patients with sub-normal LVEF (≤60%). Methods A cross-sectional survey of HF patients and their CGs was conducted in France, Germany, Italy, Spain and the UK. Cardiologists and primary care physicians completed patient record forms (PRF) between June and November 2019. Caregivers of the same patients were invited to complete a caregiver self-completion survey, which included the Family Caregiver QoL Scale (FAMQOL) and EQ-5D. Patient demographics were derived from PRFs. Results 361 CGs (73.1% female, mean age: 58.8 yrs) and HF patients (39.9% female, mean age: 71.2 yrs) were included. 58.2% of the CGs were spouses, 23.4% a child of the patient. On average, CGs devoted 20 hrs/week in the care of HF patients; this CG time increased from 12 to 26 hrs/week with NYHA class I to III/IV of the HF patient. Further, anxiety/stress was experienced overall by 29/31% of CGs which increased from 27/17% for NYHA I to 40/41% for NYHA III/IV of the HF patient (Table 1). Conclusions Caregivers of patients with HF and LVEF ≤60% spend a significant amount of time to provide daily support to HF patients. Patients with progressive disease were older, more polymorbid and had a higher disease duration. These factors likely contributed towards increased caregiver burden of HF patients with increased NYHA class. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

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Association of vitamin D insufficiency with adiposity and metabolic disorders in Brazilian adolescents

Public Health Nutrition ◽

10.1017/s1368980013001225 ◽

2013 ◽

Vol 17 (4) ◽

pp. 787-794 ◽

Cited By ~ 23

Author(s):

Renata MS Oliveira ◽

Juliana F Novaes ◽

Lorena M Azeredo ◽

Ana Paula C Cândido ◽

Isabel CG Leite

Keyword(s):

Insulin Resistance ◽

Vitamin D ◽

Parathyroid Hormone ◽

Metabolic Disorders ◽

Central City ◽

Vitamin D Insufficiency ◽

Model Assessment ◽

Cross Sectional ◽

Vitamin D Intake ◽

Dietary Record

AbstractObjectiveThe present study aimed to evaluate the frequency of deficiency/insufficiency of vitamin D in adolescents and its relationship to overweight and metabolic disorders.DesignCross-sectional study. Nutritional status was assessed by BMI according to WHO recommendations. Dietary intake was evaluated using a 3 d dietary record. The biochemical evaluation comprised measurements of serum lipids, lipoproteins, glucose, insulin, calcidiol (25(OH)D) and parathyroid hormone. Insulin resistance was calculated using the homeostasis model assessment. Body composition and blood pressure were assessed.SettingFifteen schools (eight public and seven private) in the central city of Juiz de Fora, Brazil.SubjectsThe analysis included a study population of 160 adolescents (seventy-seven eutrophic and eighty-three overweight) aged 15 to 17 years.ResultsVitamin D deficiency and insufficiency was observed in 1·25 and 70·6 % of adolescents, respectively. Serum 25(OH)D levels were statistically lower in adolescents with weight excess, abdominal obesity, hypercholesterolaemia, higher levels of parathyroid hormone, insulin resistance, hyperinsulinaemia and hypertension (P < 0·05). Lower BMI and waist circumference were observed in the third (highest) tertile of vitamin D intake for all adolescents. The high prevalence of vitamin D insufficiency is primarily nutritional and reflects a low vitamin D intake.ConclusionsOur results support the negative association among serum 25(OH)D levels and vitamin D intake with non-skeletal outcomes in Brazilian adolescents. Vitamin D fortification of foods and/or the use of vitamin D supplements need to be considered to raise vitamin D intake in the adolescent population, even in a sunny country like Brazil.

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