Serum parathyroid hormone in relation to all-cause and cardiovascular mortality: the Hoorn study

J Clin Endocrinol Metab. 2013 Apr;98(4):E638-45. doi: 10.1210/jc.2012-4007. Epub 2013 Feb 13.

Abstract

Context: Higher PTH concentrations have been associated with fatal cardiovascular diseases (CVDs), but data in the general population are scarce.

Objective: We investigated whether higher PTH concentrations are prospectively associated with all-cause and CVD mortality.

Design, setting, participants: This study used data from the Hoorn Study, a prospective population-based cohort with baseline measurements between 2000 and 2001. We included 633 participants, mean age 70.1 ± 6.6 years, 51% female. Serum intact PTH was measured using a 2-site immunoassay.

Main outcome measures: Outcomes were all-cause and CVD mortality based on clinical files and coded according to the International Classification of Diseases, ninth revision. We used Kaplan-Meier plots to estimate survival curves and Cox regression to estimate hazard ratios (HRs) using season-specific PTH quartiles.

Results: During a median follow-up of 7.8 years, 112 participants died, of which 26 deaths (23%) were cardiovascular. Survival curves by PTH quartiles differed for all-cause mortality (log-rank P = .054) and CVD mortality (log-rank P = .022). In a multivariate model, the highest PTH quartile was associated with all-cause mortality; HR = 1.98 (1.08, 3.64). Kidney function slightly attenuated the PTH risk association, but risk persisted; HR = 1.93 (1.04, 3.58). The results for CVD mortality showed a similar pattern, although the association was significant only in a threshold model (quartile 4 vs quartile 1-3); HR = 2.56 (1.11, 5.94).

Conclusions: Among a general older population, higher PTH concentrations were associated with higher all-cause mortality risk, mostly explained by fatal CVD events. We suggest to evaluate whether individuals with high PTH concentrations benefit from therapeutic approaches targeted to decrease PTH concentrations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Cohort Studies
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Osmolar Concentration
  • Parathyroid Hormone / blood*
  • Population

Substances

  • Parathyroid Hormone