Parathyroid hormone and cardiovascular disease events: A systematic review and meta-analysis of prospective studies

Ballegooijen, Adriana J. van; Reinders, Ilse; Visser, Marjolein; Brouwer, Ingeborg A.

doi:10.1016/j.ahj.2013.02.014

Cited by 118 publications

(90 citation statements)

References 36 publications

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“…The link between blood pressure and vitamin D status received great attention with mixed results as PTH was better linked with hypertension than 25OHD status [9]. The same conclusion was drawn with regard to cardiovascular diseases in a large meta-analysis by the same authors [10]. A low vitamin D status may also accelerate the cardiovascular problems of patients with chronic renal failure, especially as such patients frequently lack both the precursor 25OHD (for transforming into 1,25(OH) 2 D in all cells of the body expressing CYP27B1) and 1,25(OH) 2 D. An analysis of human data is further complicated as vitamin D status influences parathyroid hormone levels (a well-known independent cardiovascular risk factor) and calcium intake alone may provide independent risks and benefits.…”

supporting

confidence: 59%

Does a better vitamin D status help to reduce cardiovascular risks and events?

Bouillon

Verlinden

2014

Endocrine

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Vitamin D is one and maybe even the most frequently used ''drug'' in the world as it is recommended as supplement during the early years of life from infancy onwards, and is also recommended systematically for all elderly subjects with little exposure to sunlight. This is mainly inspired by the essential role of the vitamin D endocrine system for bone health [1][2][3]. The vitamin D receptor and activating enzyme, CYP27B1, are both fairly generally expressed in most tissues and the vitamin D hormone, 1,25(OH) 2 D, also regulates a great number of genes, far more than needed for calcium transport. Therefore the question and hypothesis arise that the vitamin D endocrine system would have many extra-skeletal effects and that vitamin D supplementation may help to reduce the burden of nearly all major human diseases [1][2][3]. The cardiovascular system may well be such non classical target tissue for vitamin D action based on a vast and rapidly increasing number of publications and reviews in basic and clinical journals, and even in the lay press. Two manuscripts published in the present issue of endocrine add new data for this debate.Ellis et al. [4] report that cardio respiratory fitness [measured by respiratory quotient (RQ) after moderate exercise and VO 2 max during a graded treadmill protocol] of women, aged 60 or more, is inversely correlated with serum 25OHD levels, albeit that this relation was only significant in Afro-Americans and not in Caucasians. The RQ data also suggest that a better vitamin D status was also associated with greater fat oxidation during sub maximal exercise. The study is however handicapped by the low number of subjects and by inconsistency between data in Afro-Americans and Caucasians. Moreover reverse causality is not discussed as it may well be that elderly women with greater habitual exercise have better VO 2 max and more exposure to sunlight during exercise. The second study tried to link carotid intima-media thickness (measured by ultrasonography and known to be a good surrogate marker of cardiovascular risks and events) with serum 25OHD and parathyroid hormone levels in a mixed population of vitamin D deficient (mean serum 25OHD of 13 ng/ml) patients recently admitted to a general hospital [5]. Carotid intima-media thickness correlated positively with age and body mass index, as expected, but not with serum 25OHD or parathyroid hormaone levels. There are many possible reasons for this lack of correlation including the low number of subjects with good vitamin D status and the complex mixture of patients.These two studies are in fact a good example of what is presently known with regard to the link between vitamin D status and cardiovascular risks and events. Such a link is plausible as very severe vitamin D deficiency (such as in Cyp27B1 null mice) or resistance (such as in Vdr null mice) is causing renin-mediated hypertension, decreased fibrinolysis and increased thrombogenicity [1][2][3]6]. Systemic or cardiomyocyte specific Vdr knock out also causes cardiac hypertrophy and car...

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supporting

confidence: 59%

Does a better vitamin D status help to reduce cardiovascular risks and events?

Bouillon

Verlinden

2014

Endocrine

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“…Unfortunately, there are no data in the current literature on mortality in NC-PHPT, which could help to answer this question and to better understand the role of high PTH in the presence of normocalcemia. However, a recent meta-analysis, in the general population, indicates that higher serum levels of PTH are associated with increased risk of fatal cardiovascular disease events (118).…”

Section: Primary Hyperparathyroidism and Mortality For Cardiovascularmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

129

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Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

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“…FGF-23 inhibits synthesis and PTH stimulates 1-a hydroxylation of 25-hydroxyvitamin D (17,18). Both PTH and FGF-23 have been shown to be associated with left ventricular cardiac hypertrophy and other cardiovascular disease risk factors, independent of serum phosphate concentration or dietary phosphorus intake (19)(20)(21). However, evidence that links high-phosphorus intake to elevated serum phosphate concentration in the general population with healthy renal function remains limited (22).…”

Section: Introductionmentioning

confidence: 99%

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

Calvo

Moshfegh

Tucker

2014

Advances in Nutrition

156

106

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The Western dietary pattern of intake common to many Americans is high in fat, refined carbohydrates, sodium, and phosphorus, all of which are associated with processed food consumption and higher risk of life-threatening chronic diseases. In this review, we focus on the available information on current phosphorus intake with this Western dietary pattern, and new knowledge of how the disruption of phosphorus homeostasis can occur when intake of phosphorus far exceeds nutrient needs and calcium intake is limited. Elevation of extracellular phosphorus, even when phosphorus intake is seemingly modest, but excessive relative to need and calcium intake, may disrupt the endocrine regulation of phosphorus balance in healthy individuals, as it is known to do in renal disease. This elevation in serum phosphate, whether episodic or chronically sustained, may trigger the secretion of regulatory hormones, whose actions can damage tissue, leading to the development of cardiovascular disease, renal impairment, and bone loss. Therefore, we assessed the health impact of excess phosphorus intake in the context of specific issues that reflect changes over time in the U.S. food supply and patterns of intake. Important issues include food processing and food preferences, the need to evaluate phosphorus intake in relation to calcium intake and phosphorus bioavailability, the accuracy of various approaches used to assess phosphorus intake, and the difficulties encountered in evaluating the relations of phosphorus intake to chronic disease markers or incident disease. Adv. Nutr. 5: 104-113, 2014.

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Parathyroid hormone and cardiovascular disease events: A systematic review and meta-analysis of prospective studies

Cited by 118 publications

References 36 publications

Does a better vitamin D status help to reduce cardiovascular risks and events?

Does a better vitamin D status help to reduce cardiovascular risks and events?

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

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