Parathyroid hormone and vitamin D--markers for cardiovascular and all cause mortality in heart failure

Eur J Heart Fail. 2011 Jun;13(6):626-32. doi: 10.1093/eurjhf/hfr016. Epub 2011 Mar 17.


Aims: To investigate levels of vitamin D and parathyroid hormone (PTH) in a population of heart failure (HF) patients, and to evaluate whether vitamin D and PTH are related to prognosis.

Methods and results: This was a prospective study of 148 HF outpatients (mean age 68 years, 102 men) with follow-up for mortality after 3½ years. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), PTH, 25-hydroxyvitamin D (25-OHD), and several other biomarkers were examined. Mortality and cardiovascular mortality were analysed in multivariable regression analyses adjusting for other independent prognostic variables. Vitamin D deficiency (≤50 nmol/L) was prevalent in 43% of the population; 26% had elevated PTH levels; none had primary hyperparathyroidism. We found a strong and independent significant association of both PTH and vitamin D to mortality, which was independent of other clinically important parameters [NT-proBNP, estimated glomerular filtration rate (eGFR), age, and left ventricular ejection fraction (LVEF)]. Both PTH and vitamin D were also significantly associated with all cause mortality. In an adjusted model, we found a hazard ratio of 1.9 (confidence interval 1.1-3.4) for vitamin D deficiency and 2.0 (1.0-3.8) for the upper median of PTH, respectively.

Conclusion: In this relatively small prospective study, PTH and vitamin D were independently associated with all cause and cardiovascular mortality in patients with HF. This was independent of other known risk factors such as eGFR, LVEF, NT-proBNP, and age.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cause of Death
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Heart Failure / blood*
  • Heart Failure / mortality*
  • Humans
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood*
  • Prognosis
  • Prospective Studies
  • Vitamin D / analogs & derivatives*
  • Vitamin D / blood


  • Biomarkers
  • Parathyroid Hormone
  • Vitamin D
  • 25-hydroxyvitamin D