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Wang Y, Li Q, Xu G, Yang Y, He F. Association between elevated serum parathyroid hormone and QTc interval prolongation in chronic kidney disease patients. Int Urol Nephrol 2025:10.1007/s11255-025-04479-1. [PMID: 40172614 DOI: 10.1007/s11255-025-04479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 03/21/2025] [Indexed: 04/04/2025]
Abstract
PURPOSE Heart rate-corrected (QTc) interval prolongation is frequently linked to fatal arrhythmias and sudden cardiac death in chronic kidney disease (CKD) patients. In this cross-sectional study, we assessed the prevalence of prolonged QTc intervals and identified clinical factors associated with them across different stages of kidney failure. METHODS 723 patients with CKD stages 2-5 who had electrocardiogram records available were analyzed retrospectively. QTc intervals were calculated by correcting the QT intervals for all patients included in the study. QTc interval prolongation defined as a QTc interval ˃ 440 ms was assessed for its prevalence and its association with various clinical factors. RESULTS A total of 723 patients with CKD stages 2-5 were finally included in this study, among which 420 (58.1%) were male. The average age of the participants was 48.2 ± 14.6 years old. In patients with CKD stages 2-4, the prevalence of QTc interval prolongation was 26%, 24.1%, and 37.8%, respectively. Among patients with CKD stage 5, those not on dialysis had a prevalence of 63%, while those undergoing dialysis had a prevalence of 74.3%. Multivariate logistic regression analysis revealed that elevated levels of parathyroid hormone (PTH) were significantly associated with an increased risk of QTc intervals prolongation in CKD patients (aOR = 1.384, 95% CI 1.173-1.632; P < 0.001). This suggests that higher PTH levels may contribute to QTc interval prolongation in this population. The patients were then grouped by CKD stages. Elevated PTH levels were independently associated with an increased risk of QTc interval prolongation specifically in CKD stages 4 and 5 patients who were not on dialysis. After adjusting for potential confounders, this association remained significant (CKD stage 4: aOR = 2.571, 95% CI 1.030-6.416; P < 0.001; CKD stage 5, non-dialysis: aOR = 1.333, 95% CI 1.063-1.671; P < 0.001). CONCLUSION In patients with CKD, the prevalence of QTc prolongation increases with advancing CKD stages. Specially, among patients with CKD stage 4 and stage 5 who were not on dialysis, elevated PTH levels were independently associated with an increased risk of QTc interval prolongation.
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Affiliation(s)
- Yanan Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue. 1095, Wuhan, 430030, Hubei Province, China
| | - Qing Li
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue. 1095, Wuhan, 430030, Hubei Province, China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue. 1095, Wuhan, 430030, Hubei Province, China
| | - Yi Yang
- Department of Public Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Fan He
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue. 1095, Wuhan, 430030, Hubei Province, China.
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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Fuss CT, Gronemeyer K, Hermes F, Dörr M, Schmid B, Morbach C, Schmidbauer L, Schlegel N, Fassnacht M, Koschker AC, Nordbeck P, Hannemann A, Hahner S. Cardiovascular status in chronic hypoparathyroidism: a systematic cross-sectional assessment in 168 patients. Eur J Endocrinol 2025; 192:373-384. [PMID: 40172208 DOI: 10.1093/ejendo/lvaf023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 04/04/2025]
Abstract
OBJECTIVE Long-term complications such as renal diseases are well known in patients with chronic hypoparathyroidism (hypoPT), but risk of cardiovascular comorbidity remains less clear. This study comprehensively assessed cardiovascular parameters in hypoPT compared to matched controls. DESIGN Cross-sectional cohort study involving 168 patients with chronic hypoPT. METHODS Patients underwent electrocardiograms, blood pressure measurements, and echocardiography. A 1:3 propensity score matching was performed with individuals from the German population-based Study of Health in Pomerania (SHIP-TREND) and the "Characteristics and Course of Heart Failure Stages A-B" (STAAB) cohort. RESULTS HypoPT showed significantly higher systolic (128 vs 125 mm Hg, P = .02) and diastolic blood pressures (83 vs 77 mm Hg, P < .01). Intake of antihypertensives was similar between groups. The QTc interval was markedly prolonged (438 vs 420 ms, P < .01) with QTc interval prolongation occurring significantly more frequently in hypoPT (24% vs 6%, P < .01). Interestingly, echocardiography revealed significantly lower left ventricular mass index (28 vs 43 g/m2.7, P < .01) and less frequent left ventricular hypertrophy (7%% vs 41%, P < .01) in hypoPT but comparable left ventricular ejection fraction (P = .48). HypoPT patients had higher prevalence of mitral (20 vs 0%, P < .01) and aortic valve stenoses (7 vs 2%, P < .01). Comparison with STAAB confirmed the increased prevalence of arterial hypertension and reduced myocardial mass indices. CONCLUSIONS Patients with hypoPT exhibit a higher prevalence of QTc interval prolongation despite established therapy and an increased incidence of hypertension. Conversely, echocardiography revealed lower left ventricular mass and less frequent left ventricular hypertrophy in hypoPT, but higher prevalence of valve stenosis. Regular monitoring of hypertension, QTc interval prolongation, and valve stenosis is recommended to reduce the risk of cardiovascular diseases. CLINICAL TRIAL REGISTRATION NUMBER NCT05585593.
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Affiliation(s)
- Carmina Teresa Fuss
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Karen Gronemeyer
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Franca Hermes
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, 17475 Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Benedikt Schmid
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Lena Schmidbauer
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97080 Wuerzburg, Germany
| | - Nicolas Schlegel
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Martin Fassnacht
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Ann Cathrin Koschker
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Peter Nordbeck
- Department of Medicine I, Division of Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Anke Hannemann
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, 17475 Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Stefanie Hahner
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany
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Wider J, Undyala VVR, Lanske B, Datta NS, Przyklenk K. Parathyroid Hormone-Related Peptide and Its Analog, Abaloparatide, Attenuate Lethal Myocardial Ischemia-Reperfusion Injury. J Clin Med 2022; 11:jcm11092273. [PMID: 35566399 PMCID: PMC9105604 DOI: 10.3390/jcm11092273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
Parathyroid hormone-related peptide (PTHrP) is well-known to play a role in bone formation, and abaloparatide, an analog of PTHrP(1-34), is approved for the treatment of osteoporosis in post-menopausal women. PTHrP has also been reported to have cardiovascular effects, with recent data demonstrating that exogenously administered PTHrP can limit the death of isolated cardiomyocytes subjected to oxidative stress via upregulation of classic ‘survival kinase’ signaling. Our aim in the current study was to extend this concept and, employing both in vitro and in vivo models, establish whether PTHrP(1-36) and abaloparatide are cardioprotective in the setting of lethal myocardial ischemia-reperfusion injury. We report that preischemic administration of PTHrP(1-36) and abaloparatide attenuated cell death in HL-1 cardiomyocytes subjected to simulated ischemia-reperfusion, an effect that was accompanied by the augmented expression of phospho-ERK and improved preservation of phospho-Akt, and blocked by co-administration of the MEK-ERK inhibitor PD98059. Moreover, using the translationally relevant swine model of acute coronary artery occlusion-reperfusion, we make the novel observation that myocardial infarct size was significantly reduced in pigs pretreated with PTHrP(1-36) when compared with placebo-controls (13.1 ± 3.3% versus 42.0 ± 6.6% of the area of at-risk myocardium, respectively; p < 0.01). Taken together, these data provide the first evidence in support of the concept that pretreatment with PTHrP(1-36) and abaloparatide renders cardiomyocytes resistant to lethal myocardial ischemia-reperfusion injury.
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Affiliation(s)
- Joseph Wider
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Vishnu V. R. Undyala
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, USA;
- Clinical Research Institute, Children’s Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI 48201, USA
| | | | - Nabanita S. Datta
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Karin Przyklenk
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, USA;
- Clinical Research Institute, Children’s Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Central Michigan University, Detroit, MI 48201, USA
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Correspondence:
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Zhou P, Xiao Q, Su ZT, Zhu L, Jin FX, Du XY. Effect of parathyroid hormone-related protein on intracellular calcium ion and cyclic adenosine monophosphate concentrations in cardiac fibroblasts. J Int Med Res 2021; 48:300060520931245. [PMID: 32909483 PMCID: PMC7488908 DOI: 10.1177/0300060520931245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to determine the effect of parathyroid hormone-related protein (PTHrP) on proliferation of cardiac fibroblasts (CFs) in primary cultures of neonatal Wistar rats. Methods Different PTHrP concentrations were added to CFs of neonatal Wistar rats and the cells were grouped according to the concentrations added. A verapamil (VPL) group and a calcitriol (CAL) group were also established. Changes in cell proliferation and in cyclic adenosine monophosphate and calcium ion levels were identified and recorded. Results We found that as the concentration of PTHrP increased, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT, a tetrazolium salt) colorimetric absorbance values (A values) decreased. These values in the PTHrP groups were significantly lower than those in the control group. MTT colorimetric A values and 3H-thymidine deoxyribose intake were lower in the VPL group, low-dose CAL group, and the PTHrP 10−7 mol/L group compared with the control group. However, MTT colorimetric A values and 3H-thymidine deoxyribose intake were higher in the high-dose CAL group than in the PTHrP 10−7 mol/L group. As PTHrP concentrations increased, intracellular cyclic adenosine monophosphate concentrations also increased. Conclusion PTHrp, VPL, and low-dose CAL inhibit proliferation of CFs, while high-dose CAL promotes proliferation of CFs.
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Affiliation(s)
- Ping Zhou
- Department of Pediatrics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qiong Xiao
- Department of Infectious Diseases, Children's Hospital of Harbin, Harbin City, Heilongjiang Province, China
| | - Zhao-Ting Su
- Department of Nephrology, Harbin No.4 Hospital, Harbin city, Heilongjiang province, China
| | - Lin Zhu
- Department of Pediatrics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Fang-Xia Jin
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin city, Heilongjiang province, China
| | - Xuan-Yi Du
- Department of Nephrology, Harbin No.4 Hospital, Harbin city, Heilongjiang province, China
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Adamyan SH, Harutyunyan KR, Abrahamyan HT, Khudaverdyan DN, Mkrtchian S, Ter-Markosyan AS. Can the calcium-regulating hormones counteract the detrimental impact of pro-inflammatory damage-associated molecular patterns in the development of heart failure? J Investig Med 2021; 69:1148-1152. [PMID: 33952612 PMCID: PMC8327405 DOI: 10.1136/jim-2020-001754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/08/2022]
Abstract
Growing evidence suggests an important role of the inflammatory component in heart failure (HF). Recent developments in this field indicate an ambiguous role that innate immunity plays in immune-driven HF. Damaged or stressed cells, cardiomyocytes, in particular, emit damage-associated molecular patterns (DAMPs) including HMGB1, S100 A8/A9, HSP70, and other molecules, unfolding paracrine mechanisms that induce an innate immune response. Designed as an adaptive, regenerative reaction, innate immunity may nevertheless become overactivated and thus contribute to the development of HF by altering the pacemaker rhythm, contraction, and electromechanical coupling, presumably by impairing the calcium homeostasis. The current review will explore a hypothesis of the involvement of the calcium-regulating hormones such as parathyroid hormone and parathyroid hormone–related protein in counteracting the detrimental impact of the excess of DAMPs and therefore improving the functional cardiac characteristics especially in the acute phase of the disease.
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Affiliation(s)
- Satenik H Adamyan
- Department of Physiology, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Knarik R Harutyunyan
- Department of Physiology, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Hermine T Abrahamyan
- Department of Physiology, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Drastamat N Khudaverdyan
- Department of Physiology, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
| | - Souren Mkrtchian
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anna S Ter-Markosyan
- Department of Physiology, Yerevan State Medical University named after Mkhitar Heratsi, Yerevan, Armenia
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Fuss CT, Kroiss M, Hahner S, Fassnacht M. [Hormones and The Heart - Clinical Cases]. Dtsch Med Wochenschr 2021; 146:323-329. [PMID: 33648001 DOI: 10.1055/a-1235-0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The heart is closely connected with the endocrine system. On the one hand, the heart is an endocrine organ itself and produces several hormones like atrial and brain natriuretic peptides. On the other hand, cardiac structures are targets of many hormones like catecholamines, thyroid hormones, and corticosteroids. Therefore, many endocrine diseases come with cardiac symptoms. In this article, we describe three instructive clinical cases of patients with hormonal disorders that mimicked cardiovascular disease. Furthermore, we shortly discuss useful diagnostic and treatment algorithms. All cases emphasize the value of interdisciplinary management of patients with cardiac symptoms.
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Oinonen L, Tikkakoski A, Koskela J, Eräranta A, Kähönen M, Niemelä O, Mustonen J, Pörsti I. Parathyroid hormone may play a role in the pathophysiology of primary hypertension. Endocr Connect 2021; 10:54-65. [PMID: 33289696 PMCID: PMC7923049 DOI: 10.1530/ec-20-0446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Parathyroid hormone has been related with the risk of hypertension, but the matter remains controversial. We examined the association of parathyroid hormone with central blood pressure and its determinants in 622 normotensive or never-treated hypertensive subjects aged 19-72 years without diabetes, cardiovascular or renal disease, or cardiovascular medications. The methods were whole-body impedance cardiography and analyses of pulse wave and heart rate variability. Cardiovascular function was examined in sex-specific tertiles of plasma parathyroid hormone (mean concentrations 3.0, 4.3 and 6.5 pmol/L, respectively) during head-up tilt. Explanatory factors for haemodynamics were further investigated using linear regression analyses. Mean age was 45.0 (s.d. 11.7) years, BMI 26.8 (4.4) kg/m2, seated office blood pressure 141/90 (21/12) mmHg, and 309 subjects (49.7%) were male. Only five participants had elevated plasma parathyroid hormone and calcium concentrations. Highest tertile of parathyroid hormone presented with higher supine and upright aortic diastolic blood pressure (P < 0.01) and augmentation index (P < 0.01), and higher upright systemic vascular resistance (P < 0.05) than the lowest tertile. The tertiles did not present with differences in pulse wave velocity, cardiac output, or measures of heart rate variability. In linear regression analyses, parathyroid hormone was an independent explanatory factor for aortic systolic (P = 0.005) and diastolic (P = 0.002) blood pressure, augmentation index (P = 0.002), and systemic vascular resistance (P = 0.031). To conclude, parathyroid hormone was directly related to central blood pressure, wave reflection, and systemic vascular resistance in subjects without cardiovascular comorbidities and medications. Thus, parathyroid hormone may play a role in the pathophysiology of primary hypertension.
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Affiliation(s)
- Lasse Oinonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Correspondence should be addressed to L Oinonen:
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Abstract
Calcium has long been known to be essential to cardiac electrical activity. Parathyroid hormone (PTH) is the main regulator of serum calcium and is central to calcium homeostasis. Although there are significant data linking parathyroid disease states with changes in cardiac electrophysiology, most data have focused on how PTH modulates serum calcium to produce these effects. Close scrutiny of early literature demonstrates that the relationship between PTH and electrocardiographic changes is not straightforward, and numerous studies have linked PTH to arrhythmia. Basic science research has demonstrated that there is a basis for a direct role of PTH on cardiac electrophysiology outside of its effect on serum calcium. Later studies in secondary hyperparathyroidism indicate that PTH disturbances could have important implications for broad categories of patients with cardiovascular disease. The current review summarizes the existing literature on PTH and electrophysiology based on clinical and basic science studies of various parathyroid states, providing directions for future study.
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Increased Serum Parathyroid Hormone, Osteocalcin and Alkaline Phosphatase Are Associated with a Long-Term Adverse Cardiovascular Outcome after Coronary Artery Bypass Graft Surgery. Diagnostics (Basel) 2019; 9:diagnostics9040143. [PMID: 31597282 PMCID: PMC6963598 DOI: 10.3390/diagnostics9040143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 01/03/2023] Open
Abstract
Despite the fact that an association of osteopoenia/osteoporosis with elevated risk of coronary artery calcification (CAC) and coronary atherosclerosis (CA) is well-established, it remains unclear whether bone turnover markers can be employed in long-term prognostication of such patients. Here we measured serum calcium, phosphate, calcitonin, parathyroid hormone (PTH), osteoprotegerin, osteocalcin, osteopontin, alkaline phosphatase and its bone isoenzyme, subsequently correlating them with an adverse cardiovascular outcome after 3 years of follow-up. The extent of brachiocephalic artery stenosis, CA, or CAC, as well as prevalence of osteopoenia/osteoporosis before the coronary artery bypass graft (CABG) surgery, did not differ between outcome groups, suggesting that subtle molecular mechanisms might be involved in determining the outcome rather than clinical or subclinical disease. After stepwise logistic regression, serum osteocalcin > 26.8 ng/mL and PTH > 49.1 pg/mL were independent predictors of an adverse outcome. Serum ionised calcium correlated with multivessel coronary artery disease; moreover, patients with severe CA (SYNTAX score > 21) had higher serum ionised calcium than those with mild CA. Likewise, serum alkaline phosphatase was associated with severe CA and CAC (Agatston score > 400). In conclusion, serum PTH, osteocalcin, and alkaline phosphatase are associated with an adverse cardiovascular outcome 3 years after CABG surgery regardless of osteopoenia/osteoporosis, coronary/peripheral atherosclerosis, and CAC.
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Underbjerg L, Sikjaer T, Rejnmark L. Cardiovascular findings in patients with nonsurgical hypoparathyroidism and pseudohypoparathyroidism: A cohort study. Clin Endocrinol (Oxf) 2019; 90:592-600. [PMID: 30589959 DOI: 10.1111/cen.13927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE As only sparse data are available on indices of cardiovascular health among patients with nonsurgical hypoparathyroidism (Ns-HypoPT) and pseudohypoparathyroidism (PHP), we aimed to compare the cardiovascular profile between these groups of patients. METHODS A total of 56 patients with Ns-HypoPT and 30 with PHP were included and underwent a clinical examination including blood sampling and measurements of arterial stiffness, pulse wave velocity (PWV) and blood pressure (BP). Arterial stiffness and PWV were measured using AtCor SphygmoCor-XCEL (Atcor Medical Pty Ltd, Sydney, NSW, Australia). RESULTS Patients with Ns-HypoPT had an average age of 47 ± 17 years (68% females) and PHP patients 36 ± 13 years (80% females). Over 70% in both groups were genetically screened. Groups did not differ in terms of a history of cardiovascular disease, smoking status, use of calcium and vitamin D supplements or treatment with cholesterol-lowering or antihypertensive drugs. Compared with Ns-HypoPT, PHP patients had significantly lower levels of high-density lipoproteins (HDL) cholesterol and average glucose from HbA1c (Pboth = 0.01). PWV was significantly higher among patients with Ns-HypoPT (Pcrude = 0.02), even after adjustment for mean arterial pressure, body mass index, age and gender (Padjusted < 0.01). Heart rate was significantly higher in Ns-HypoPT compared with PHP (P = 0.03). Office BP and 24-hour ambulatory BP did not differ between groups (P > 0.05). CONCLUSION Patients with Ns-HypoPT have compared with PHP a higher arterial stiffness and heart rate. This has been associated with an increased risk of cardiovascular disease. Our data suggest that resistance to PTH is present in the cardiovascular system in PHP.
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Affiliation(s)
- Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Ginsberg C, Craven TE, Chonchol MB, Cheung AK, Sarnak MJ, Ambrosius WT, Killeen AA, Raphael KL, Bhatt UY, Chen J, Chertow GM, Freedman BI, Oparil S, Papademetriou V, Wall BM, Wright CB, Ix JH, Shlipak MG, for the SPRINT Research Group. PTH, FGF23, and Intensive Blood Pressure Lowering in Chronic Kidney Disease Participants in SPRINT. Clin J Am Soc Nephrol 2018; 13:1816-1824. [PMID: 30425104 PMCID: PMC6302330 DOI: 10.2215/cjn.05390518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/06/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive BP lowering reduced the risk of cardiovascular disease, but increased eGFR decline. Serum parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) concentrations are elevated in CKD and are associated with cardiovascular disease. We evaluated whether intact PTH or intact FGF23 concentrations modify the effects of intensive BP control on cardiovascular events, heart failure, and all-cause mortality in SPRINT participants with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We measured PTH and FGF23 in 2486 SPRINT participants with eGFR<60 ml/min per 1.73 m2 at baseline. Cox models were used to evaluate whether serum PTH and FGF23 concentrations were associated with cardiovascular events, heart failure, and all-cause mortality, and whether PTH and FGF23 modified the effects of intensive BP control. RESULTS The mean age of this subcohort was 73 years, 60% were men, and mean eGFR was 46±11 ml/min per 1.73 m2. Median PTH was 48 (interquartile range [IQR], 35-67) pg/ml and FGF23 was 66 (IQR, 52-88) pg/ml. There were 261 composite cardiovascular events, 102 heart failure events, and 179 deaths within the subcohort. The adjusted hazard ratio (HR) per doubling of PTH concentration for cardiovascular events, heart failure, and all-cause mortality were 1.29 (95% confidence interval [95% CI], 1.06 to 1.57), 1.32 (95% CI, 0.96 to 1.83), and 1.04 (95% CI, 0.82 to 1.31), respectively. There were significant interactions between PTH and BP arm for both the cardiovascular (P-interaction=0.01) and heart failure (P-interaction=0.004) end points. Participants with a PTH above the median experienced attenuated benefits of intensive BP control on cardiovascular events (adjusted HR, 1.02; 95% CI, 0.72 to 1.42) compared with participants with a PTH below the median (adjusted HR, 0.67; 95% CI, 0.45 to 1.00). FGF23 was not independently associated with any outcome and did not modify the effects of the intervention. CONCLUSIONS SPRINT participants with CKD and a high serum PTH received less cardiovascular protection from intensive BP therapy than participants with a lower serum PTH.
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Affiliation(s)
- Charles Ginsberg
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | | | - Michel B. Chonchol
- Division of Renal Diseases and Hypertension, University of Anschutz Medical Center, Aurora, Colorado
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Mark J. Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | - Anthony A. Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Udayan Y. Bhatt
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jing Chen
- Nephrology and Hypertension Section, Tulane University School of Medicine, New Orleans, Louisiana
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Barry I. Freedman
- Nephrology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Suzanne Oparil
- Division of Cardiovascular Disease, University of Alabama School of Medicine, Birmingham, Alabama
| | | | - Barry M. Wall
- Division of Nephrology, Veterans Affairs Medical Center, Memphis, Tennessee
| | | | - Joachim H. Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, Veterans Affairs Medical Center, San Francisco, California; and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - for the SPRINT Research Group
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California
- Department of Biostatistical Sciences and
- Nephrology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Renal Diseases and Hypertension, University of Anschutz Medical Center, Aurora, Colorado
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
- Nephrology and Hypertension Section, Tulane University School of Medicine, New Orleans, Louisiana
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
- Division of Cardiovascular Disease, University of Alabama School of Medicine, Birmingham, Alabama
- Division of Cardiology, Georgetown University Medical Center, Washington, DC
- Division of Nephrology, Veterans Affairs Medical Center, Memphis, Tennessee
- Department of Neurology, University of Miami, Miami, Florida
- Kidney Health Research Collaborative, Veterans Affairs Medical Center, San Francisco, California; and
- Department of Medicine, University of California, San Francisco, San Francisco, California
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12
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Loh HH, Yee A, Loh HS. Bone health among patients with primary aldosteronism: a systematic review and meta-analysis. MINERVA ENDOCRINOL 2018; 44:387-396. [PMID: 30482008 DOI: 10.23736/s0391-1977.18.02867-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Recent studies showed a possible association between hyperaldosteronism and secondary hyperparathyroidism leading to reduced bone health, however results are conflicting. EVIDENCE ACQUISITION We conducted a meta-analysis to evaluate the relationship between primary aldosteronism (PA) with bone biochemical markers and to assess bone mineral density in patients with primary aldosteronism. EVIDENCE SYNTHESIS A total of 939 subjects were examined (37.5% with PA). Patients with PA had significantly higher serum parathyroid hormone, lower serum calcium, higher urine calcium excretion and higher serum alkaline phosphatase compared to patients without PA, with no significant difference in serum vitamin D between both groups. Bone mineral density of lumbar spine, femoral neck and total neck of femur were similar between two groups. With PA treatment, there was a significant increment in serum calcium and reduction in serum parathyroid hormone. CONCLUSIONS PA is associated with hypercalciuria with subsequent secondary hyperparathyroidism. This potentially affects bone health. We recommend this to be part of complication screening among patients with PA.
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Affiliation(s)
- Huai H Loh
- Faculty of Medicine and Health Sciences, University of Malaysia, Sarawak, Malaysia -
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Huai S Loh
- Clinical Academic Unit, Newcastle University Medicine Malaysia, Johor, Malaysia
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Wu GY, Wu T, Xu BD, Shi YC, Cheng ZY, Zhang X, Wang X, Zong GJ. Effect of parathyroid hormone on cardiac function in rats with cardiomyopathy. Exp Ther Med 2018; 16:2859-2866. [PMID: 30214507 PMCID: PMC6125823 DOI: 10.3892/etm.2018.6528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/29/2018] [Indexed: 02/02/2023] Open
Abstract
The present study investigated the role of parathyroid hormone (PTH) in non-ischemic cardiomyopathy (CM) and its underlying mechanism. A total of 30 Sprague-Dawley male rats were randomly divided into a control group (n=6) and an experimental group (n=24). To induce CM in the rats of the experimental group, 2 mg/kg Adriamycin (ADR) was administered intraperitoneally with 5 equal injections every third day followed by 5 weekly injections resulting in a cumulative dose of 20 mg/kg. Following establishment of the model, rats in the experimental group were subdivided into a PTH-untreated CM group that received daily normal saline subcutaneous injections for 7 days and three treated CM groups that received daily subcutaneous injections of 5, 10, or 20 µg/kg of recombinant PTH for 7 days. Rats in the control group accordingly received intraperitoneal and subcutaneous injections of normal saline. Blood sample analysis revealed that B-type natriuretic peptide (BNP), troponin T, C-reactive protein (CRP), creatinine and phosphorus concentrations were increased in the PTH-untreated CM group compared with that in the control group, whereas PTH and calcium concentrations were decreased. Administration of PTH dose-dependently decreased BNP, CRP, creatinine and phosphorus levels, and increased PTH and calcium levels. Notably, there were significant differences in PTH, BNP, troponin T, CRP, creatinine, calcium, and phosphorus levels among the rats in the five groups (P<0.01). Cardiac ultrasonography results indicated that the left ventricular ejection fraction (LVEF) was significantly decreased in rats treated with ADR compared with the rats from the control group (P<0.01). However, the LVEF gradually recovered with elevated PTH treatment doses. The overall differences of LVEF and left ventricular end-systolic volume in the five experimental groups were statistically significant (P<0.01). Furthermore, there were dose-dependent increases in LV mass and left ventricular end-diastolic volume in PTH-treated rats; however, the differences between any two groups did not reach statistical significance (P>0.05). Immunohistochemical staining and western blot analysis using an anti-PTH polyclonal antibody was performed to evaluate the protein expression levels of PTH in myocardial tissues. The mRNA expression levels of PTH and BNP were measured using reverse transcription-quantitative polymerase chain reaction. The results demonstrated that the mRNA and protein expression levels of PTH in myocardial tissues were significantly decreased in ADR-treated rats compared with the levels in the control group rats. Injection of recombinant PTH significantly increased PTH expression and reduced BNP expression in dose-dependent manners (P<0.05). These findings demonstrated that PTH can improve cardiac function in rats with ADR-induced CM, suggesting a potential therapeutic application for PTH in non-ischemic CM.
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Affiliation(s)
- Gang-Yong Wu
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Ting Wu
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Bai-Da Xu
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Yi-Cheng Shi
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Zhi-Yuan Cheng
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Xiao Zhang
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Xiao Wang
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
| | - Gang-Jun Zong
- Department of Cardiology, 101 Hospital of PLA, Wuxi Clinical Hospital, Anhui Medical University, Wuxi, Jiangsu 214044, P.R. China
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14
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Palmeri NO, Davidson KW, Whang W, Kronish IM, Edmondson D, Walker MD. Parathyroid hormone is related to QT interval independent of serum calcium in patients with coronary artery disease. Ann Noninvasive Electrocardiol 2017; 23:e12496. [PMID: 28949082 DOI: 10.1111/anec.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Elevated serum parathyroid hormone (PTH) is associated with increased risk of cardiovascular death, including sudden cardiac death, in patients with and without parathyroid disease. In small studies, PTH levels have been associated with changes in cardiac conduction and repolarization. Changes in the corrected QT interval (QTc) in particular are thought to be mediated by the effect of PTH on serum calcium. There is limited evidence to suggest PTH may affect cardiac physiology independent of its effects on serum calcium, but there is even less data linking PTH to changes in electrical conduction and repolarization independent of serum calcium. METHODS ECG data were examined from the PULSE database-an observational cohort study designed to examine depression after acute coronary syndromes (ACS) at a single, urban American medical center. In all, 407 patients had PTH and ECG data for analysis. RESULTS The QTc was longer in patients with elevated PTH levels compared with those without elevated PTH levels (451 ± 38.6 ms vs. 435 ± 29.8 ms; p < .001). The difference remained statistically significant after controlling for calcium, vitamin D, and estimated glomerular filtration rate (p = .007). Inclusion of left ventricular ejection fraction in the model attenuated the association (p = .054), suggesting that this finding may be partly driven by changes in cardiac structure. CONCLUSIONS In one of the largest series to examine PTH, calcium, and QT changes, we found that elevated PTH is associated with longer corrected QT interval independent of serum calcium concentration in ACS survivors.
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Affiliation(s)
| | | | | | - Ian M Kronish
- Columbia University Medical Center, New York, NY, USA
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15
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Datta T, Przyklenk K, Datta NS. Parathyroid Hormone-Related Peptide: A Novel Endocrine Cardioprotective "Conditioning Mimetic". J Cardiovasc Pharmacol Ther 2017; 22:529-537. [PMID: 28403647 DOI: 10.1177/1074248417702976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An as-yet limited body of evidence suggests that calcium-regulating endocrine hormones-in particular, parathyroid hormone-related peptide (PTHrP)-may have unappreciated cardioprotective effects. The current review focuses on the concept that PTHrP may, via modulation of classic cardioprotective signaling pathways, provide a novel strategy to attenuate myocardial ischemia-reperfusion injury.
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Affiliation(s)
- Tanuka Datta
- 1 Department of Internal Medicine, George Washington University, Washington, DC, USA
| | - Karin Przyklenk
- 2 Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA.,3 Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA.,4 Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nabanita S Datta
- 2 Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA.,5 Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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16
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An Expanded View of Progressive Cardiorenal Disorders. Am J Med Sci 2016; 351:626-33. [DOI: 10.1016/j.amjms.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/17/2016] [Indexed: 11/23/2022]
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17
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Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary arterial hypertension. Beyond its effects on intravascular volume and blood pressure, PA causes metabolic alterations and a higher cardiovascular morbidity, which is reduced by PA-directed therapy. Experimental studies demonstrated that mineralocorticoid excess may also influence mineral homeostasis. A role in cardiovascular disease has also been attributed to parathyroid hormone (PTH). Increasing evidence supports a bidirectional interaction between aldosterone and PTH.Primary hyperparathyroidism is associated with arterial hypertension and an increased cardiovascular morbidity and mortality, which might be associated to higher aldosterone values; parathyreoidectomy results in lowered aldosterone and blood pressure levels. PA leads to secondary hyperparathyroidism, which is reversible by PA-directed therapy. A lower bone mineral density and a higher fracture rate were also shown to be reversible by PA-directed therapy. There is a suspicion of a bidirectional interaction between aldosterone and PTH, which might lead to a higher cardiovascular risk. There are more and more reports about coincident PA and primary hyperparathyroidism. From a pathophysiologic point of view this constellation is best characterized as tertiary hyperparathyroidism. Future aspects should further clarify the extent of these endocrine interactions and analyze the influence of this interplay on cardiovascular morbidity and mortality and bone health.
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Affiliation(s)
- E Asbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - M Bekeran
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - M Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
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18
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Bansal N, Zelnick L, Robinson-Cohen C, Hoofnagle AN, Ix JH, Lima JA, Shoben AB, Peralta CA, Siscovick DS, Kestenbaum B, de Boer IH. Serum parathyroid hormone and 25-hydroxyvitamin D concentrations and risk of incident heart failure: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2014; 3:e001278. [PMID: 25468653 PMCID: PMC4338718 DOI: 10.1161/jaha.114.001278] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Heart failure (HF) is common and is associated with high mortality. We aimed to determine associations of serum parathyroid hormone (PTH) and 25‐hydroxyvitamin D (25[OH]D) with incident HF and left ventricular mass. Methods and Results Among 6459 participants in the community‐based Multi‐Ethnic Study of Atherosclerosis, all of whom were free of prevalent clinical cardiovascular disease, we measured serum concentrations of PTH and 25(OH)D at the baseline examination. In longitudinal analyses, we tested associations of PTH and 25(OH)D with incident HF events, adjudicated by a panel of physicians. In cross‐sectional analyses of a subset of 4763 participants, we tested associations of PTH and 25(OH)D with left ventricular mass, measured by cardiac magnetic resonance imaging at baseline. Multivariable Cox proportional hazard and linear regression models were adjusted for demographics, physical examination measures, comorbidity, kidney function, and other mineral metabolism markers. Mean age was 62 years and 53% of participants were female. There were 180 incident HF events over a median (interquartile range) follow‐up time of 8.46 (7.67 to 8.63) years. Compared with participants with PTH <65 pg/mL, PTH ≥65 pg/mL was associated with a 50% greater risk of incident HF (95% CI: 3% to 210%) and a 5.3 g higher left ventricular mass (95% CI: 2.6, 7.9 g). In contrast, there was no association of 25(OH)D with risk of incident HF or elevated left ventricular mass. Conclusions In a racially/ethnically diverse population without prevalent cardiovascular disease, higher serum PTH concentration was associated with increased left ventricular mass and increased risk of incident HF. Further studies should be pursued to determine whether PTH excess may be a modifiable risk factor for HF.
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Affiliation(s)
- Nisha Bansal
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Leila Zelnick
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Cassianne Robinson-Cohen
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Andy N Hoofnagle
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Joachim H Ix
- University of California, San Diego, CA (J.H.I.)
| | - Joao A Lima
- Johns Hopkins University, Baltimore, MD (J.A.L.)
| | | | | | | | - Bryan Kestenbaum
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
| | - Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, WA (N.B., L.Z., C.R.C., A.N.H., B.K., I.H.B.)
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19
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Nishikawa N, Kanematsu A, Negoro H, Imamura M, Sugino Y, Okinami T, Yoshimura K, Hashitani H, Ogawa O. PTHrP is endogenous relaxant for spontaneous smooth muscle contraction in urinary bladder of female rat. Endocrinology 2013; 154:2058-68. [PMID: 23546599 DOI: 10.1210/en.2012-2142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Acute bladder distension causes various morphologic and functional changes, in part through altered gene expression. We aimed to investigate the physiologic role of PTHrP, which is up-regulated in an acute bladder distension model in female rats. In the control Empty group, bladders were kept empty for 6 hours, and in the Distension group, bladders were kept distended for 3 hours after an artificial storing-voiding cycle for 3 hours. In the Distention group bladder, up-regulation of transcripts was noted for 3 genes reported to be up-regulated by stretch in the cultured bladder smooth muscle cells in vitro. Further transcriptome analysis by microarray identified PTHrP as the 22nd highest gene up-regulated in Distension group bladder, among more than 27,000 genes. Localization of PTHrP and its functional receptor, PTH/PTHrP receptor 1 (PTH1R), were analyzed in the untreated rat bladders and cultured bladder cells using real-time RT-PCR and immunoblotting, which revealed that PTH1R and PTHrP were more predominantly expressed in smooth muscle than in urothelium. Exogenous PTHrP peptide (1-34) increased intracellular cAMP level in cultured bladder smooth muscle cells. In organ bath study using bladder strips, the PTHrP peptide caused a marked reduction in the amplitude of spontaneous contraction but caused only modest suppression for carbachol-induced contraction. In in vivo functional study by cystometrogram, the PTHrP peptide decreased voiding pressure and increased bladder compliance. Thus, PTHrP is a potent endogenous relaxant of bladder contraction, and autocrine or paracrine mechanism of the PTHrP-PTH1R axis is a physiologically relevant pathway functioning in the bladder.
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MESH Headings
- Animals
- Carbachol/pharmacology
- Cells, Cultured
- Cholinergic Agonists/pharmacology
- Cyclic AMP/metabolism
- Female
- Gene Expression Profiling
- Immunoblotting
- In Vitro Techniques
- Muscle Contraction/genetics
- Muscle Contraction/physiology
- Muscle, Smooth/metabolism
- Muscle, Smooth/physiopathology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Oligonucleotide Array Sequence Analysis
- Parathyroid Hormone-Related Protein/genetics
- Parathyroid Hormone-Related Protein/metabolism
- Parathyroid Hormone-Related Protein/physiology
- Peptide Fragments/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptor, Parathyroid Hormone, Type 1/genetics
- Receptor, Parathyroid Hormone, Type 1/metabolism
- Receptor, Parathyroid Hormone, Type 1/physiology
- Reverse Transcriptase Polymerase Chain Reaction
- Urinary Bladder/metabolism
- Urinary Bladder/physiopathology
- Urinary Retention/genetics
- Urinary Retention/metabolism
- Urinary Retention/physiopathology
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Affiliation(s)
- Nobuyuki Nishikawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan
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20
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Raison D, Coquard C, Hochane M, Steger J, Massfelder T, Moulin B, Karaplis AC, Metzger D, Chambon P, Helwig JJ, Barthelmebs M. Knockdown of parathyroid hormone related protein in smooth muscle cells alters renal hemodynamics but not blood pressure. Am J Physiol Renal Physiol 2013; 305:F333-42. [PMID: 23720345 DOI: 10.1152/ajprenal.00503.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parathyroid hormone-related protein (PTHrP) belongs to vasoactive factors that regulate blood pressure and renal hemodynamics both by reducing vascular tone and raising renin release. PTHrP is expressed in systemic and renal vasculature. Here, we wanted to assess the contribution of vascular smooth muscle cell endogenous PTHrP to the regulation of cardiovascular and renal functions. We generated a mouse strain (SMA-CreERT2/PTHrPL2/L2 or premutant PTHrPSM-/-), which allows temporally controlled, smooth muscle-targeted PTHrP knockdown in adult mice. Tamoxifen treatment induced efficient recombination of PTHrP-floxed alleles and decreased PTHrP expression in vascular and visceral smooth muscle cells of PTHrPSM-/- mice. Blood pressure remained unchanged in PTHrPSM-/- mice, but plasma renin concentration and creatinine clearance were reduced. Renal hemodynamics were further analyzed during clearance measurements in anesthetized mice. Conditional knockdown of PTHrP decreased renal plasma flow and glomerular filtration rate with concomitant reduction in filtration fraction. Similar measurements were repeated during acute saline volume expansion. Saline volume expansion induced a rise in renal plasma flow and reduced filtration fraction; both were blunted in PTHrPSM-/- mice leading to impaired diuresis. These findings show that endogenous vascular smooth muscle PTHrP controls renal hemodynamics under basal conditions, and it is an essential factor in renal vasodilation elicited by saline volume expansion.
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Affiliation(s)
- Denis Raison
- Institut National de la Santé et de la Recherche Médicale (INSERM), U682, Equipe Cancer du rein et Physiopathologie rénale, Faculté de Médecine, Strasbourg, France
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Fisher A, Srikusalanukul W, Davis M, Smith P. Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links. Clin Interv Aging 2013; 8:239-56. [PMID: 23460043 PMCID: PMC3585505 DOI: 10.2147/cia.s38856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. AIMS AND METHODS To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. RESULTS CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. CONCLUSION SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.
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Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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22
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Tomaschitz A, Ritz E, Pieske B, Fahrleitner-Pammer A, Kienreich K, Horina JH, Drechsler C, März W, Ofner M, Pieber TR, Pilz S. Aldosterone and parathyroid hormone: a precarious couple for cardiovascular disease. Cardiovasc Res 2012; 94:10-9. [PMID: 22334595 DOI: 10.1093/cvr/cvs092] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Animal and human studies support a clinically relevant interaction between aldosterone and parathyroid hormone (PTH) levels and suggest an impact of the interaction on cardiovascular (CV) health. This review focuses on mechanisms behind the bidirectional interactions between aldosterone and PTH and their potential impact on the CV system. There is evidence that PTH increases the secretion of aldosterone from the adrenals directly as well as indirectly by activating the renin-angiotensin system. Upregulation of aldosterone synthesis might contribute to the higher risk of arterial hypertension and of CV damage in patients with primary hyperparathyroidism. Furthermore, parathyroidectomy is followed by decreased blood pressure levels and reduced CV morbidity as well as lower renin and aldosterone levels. In chronic heart failure, the aldosterone activity is inappropriately elevated, causing salt retention; it has been argued that the resulting calcium wasting causes secondary hyperparathyroidism. The ensuing intracellular calcium overload and oxidative stress, caused by PTH and amplified by the relative aldosterone excess, may increase the risk of CV events. In the setting of primary aldosteronism, renal and faecal calcium loss triggers increased PTH secretion which in turn aggravates aldosterone secretion and CV damage. This sequence explains why adrenalectomy and blockade of the mineralocorticoid receptor tend to decrease PTH levels in patients with primary aldosteronism. In view of the reciprocal interaction between aldosterone and PTH and the potentially ensuing CV damage, studies are urgently needed to evaluate diagnostic and therapeutic strategies addressing the interaction between the two hormones.
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Affiliation(s)
- Andreas Tomaschitz
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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Busija AR, Fridolfsson HN, Patel HH. A new sense of protection: role of the Ca2+-sensing receptor in ischemic preconditioning. Am J Physiol Heart Circ Physiol 2010; 299:H1300-1. [PMID: 20852055 DOI: 10.1152/ajpheart.00903.2010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sun J, Murphy E. Calcium-sensing receptor: a sensor and mediator of ischemic preconditioning in the heart. Am J Physiol Heart Circ Physiol 2010; 299:H1309-17. [PMID: 20833954 DOI: 10.1152/ajpheart.00373.2010] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As a G protein-coupled receptor, the extracellular Ca(2+)-sensing receptor (CaSR) responds to changes not only in extracellular Ca(2+), but also to many other ligands. CaSR has been found to be expressed in the hearts and cardiovascular system. In this study, we confirmed that CaSR is expressed in mouse cardiomyocytes and showed that it is predominantly localized in caveolae. The goal of this study was to investigate whether CaSR plays a cardioprotective role in ischemic preconditioning (IPC). Hearts from C57BL/6J mice (male, 12-16 wk) were perfused in the Langendorff mode and subjected to the following treatments: 1) control perfusion; 2) perfusion with a specific CaSR antagonist, NPS2143; 3) IPC (four cycles of 5 min of global ischemia and 5 min of reperfusion); or 4) perfusion with NPS2143 before and during IPC. Following these treatments, hearts were subjected to 20 min of no-flow global ischemia and 120 min of reperfusion. Compared with control, IPC significantly improved postischemic left ventricular functional recovery and reduced infarct size. Although NPS2143 perfusion alone did not change the hemodynamic function and did not change the extent of postischemic injury, NPS2143 treatment abolished cardioprotection of IPC. Through immunoblot analysis, it was demonstrated that IPC significantly increased the levels of phosphorylated ERK1/2, AKT, and GSK-3β, which were also prevented by NPS2143 treatment. Taken together, the distribution of CaSR in caveolae along with NPS2143-blockade of IPC-induced cardioprotective signaling suggest that the activation of CaSR during IPC is cardioprotective by a process involving caveolae.
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Affiliation(s)
- Junhui Sun
- Translational Medicine Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bldg 10/Rm 8N206, Bethesda, MD 20892,USA.
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Ischemic injury and the parathyroid hormone-related protein system: friend or foe? Basic Res Cardiol 2009; 104:424-6. [PMID: 19377853 DOI: 10.1007/s00395-009-0784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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