Secondary Hyperparathyroidism in Patients with Untreated and Treated Congestive Heart Failure

Khouzam, Rami N.; Dishmon, Dwight A.; Farah, Victor; Flax, Sherri; Carbone, Laura D; Weber, Karl T.

doi:10.1097/00000441-200601000-00009

Cited by 49 publications

(40 citation statements)

References 34 publications

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“…This response is exacerbated in people with 25[OH]D deficiency [30,31]. The consequences of 25[OH]D deficiency [32] and elevated PTH levels [33][34][35][36] are calcium loading, with cardiomyocyte and skeletal muscle contractile dysfunction, cellular hypertrophy, oxidative stress, immune activation, endothelial dysfunction (including enhanced endothelin-1 release) [30,34,[37][38][39][40][41]. These influences are reflected clinically with an increased risk of hospitalisation [7,42], and worsening renal function [43], whilst vitamin D supplementation may be associated with a reduction of plasma renin and aldosterone levels [44,45].…”

Section: Why Might Vitamin D Be Important In Chronic Heart Failure?mentioning

confidence: 99%

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

et al. 2018

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Section: Why Might Vitamin D Be Important In Chronic Heart Failure?mentioning

confidence: 99%

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

et al. 2018

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“…Serum levels of 25(OH)D, a marker of vitamin D stores, are reduced in AA and are associated with increased circulating parathyroid hormone (PTH) [9][10][11][12][13][14][15][16][17]. This 25(OH)D-PTH profile raises several issues.…”

Section: Introductionmentioning

confidence: 99%

“…Sunlight exposure is reduced in communitydwelling AA residing in urban locations, especially in winter [14]. Irrespective of the time of year, outdoor activities are reduced in AA housebound with symptomatic heart failure [16,17]. In response to EDTA-induced reductions in serumionized [Ca 2+ ] o the secretion of PTH is markedly increased in AA with hypovitaminosis D [19].…”

Section: Introductionmentioning

confidence: 99%

Macro- and micronutrients in African-Americans with heart failure

et al. 2006

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An emerging body of evidence suggests secondary hyperparathyroidism (SHPT) may be an important covariant of congestive heart failure (CHF), especially in African-Americans (AA) where hypovitaminosis D is prevalent given that melanin, a natural sunscreen, mandates prolonged exposure of skin to sunlight and where a housebound lifestyle imposed by symptomatic CHF limits outdoor activities and hence sunlight exposure. In addition to the role of hypovitaminosis D in contributing to SHPT is the increased urinary and fecal losses of macronutrients Ca(2+) and Mg(2+) associated with the aldosteronism of CHF and their heightened urinary losses with furosemide treatment of CHF. Thus, a precarious Ca(2+) balance seen with reduced serum 25(OH)D is further compromised when AA develop CHF with circulating RAAS activation and are then treated with a loop diuretic. SHPT accounts for a paradoxical Ca(2+) overloading of diverse tissues and the induction of oxidative stress at these sites which spills over to the systemic circulation. In addition to SHPT, hypozincemia and hyposelenemia have been found in AA with compensated and decompensated heart failure and where an insufficiency of these micronutrients may have its origins in inadequate dietary intake, altered rates of absorption or excretion and/or tissue redistribution, and treatment with an ACE inhibitor or AT(1) receptor antagonist. Zn and Se deficiencies, which compromise the activity of several endogenous antioxidant defenses, could prove contributory to the severity of heart failure and its progressive nature. These findings call into question the need for nutriceutical treatment of heart failure and which is complementary to today's pharmaceuticals, especially in AA.

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“…29,30 Though prior studies have shown similar associations, this is the largest study to date that has evaluated this relationship in patients with CKD. 31,32 Moreover, this study attempts to explain the clinical association between the use of aldosterone antagonists and observed changes in PTH levels. 20 These findings are consistent with basic scientific literature supporting the claim that aldosterone-mediated effects on tissues rely on MR sensitivity and signaling.…”

Section: Discussionmentioning

confidence: 99%

Interplay of parathyroid hormone and aldosterone antagonist in prevention of heart failure hospitalizations in chronic kidney disease

Hassan

Qureshi

Sroujieh

et al. 2014

J Renin Angiotensin Aldosterone Syst

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Background: Aldosterone antagonists may mediate their effects on heart failure through parathyroid hormone (PTH) in chronic kidney disease (CKD) patients. Methods: Patients with CKD on spironolactone were selected and matched for age, gender, race, use of a vitamin D analogue, the number of antihypertensive medications, and CKD stage. PTH levels before and after the first prescription of spironolactone were measured. A thorough chart review was conducted to assess for heart failure hospitalizations. An adjusted Cox proportional model was used to calculate the hazard ratio (HR) for heart failure hospitalizations among cases versus controls. Results: There were a total of 950 (mean age 67±13 years, 40% men) patients with CKD. Of these, there were 48 hospitalizations for heart failure among the cases and 82 among the controls (HR 0.37; 95% confidence interval (CI) 0.19-0.74, p=0.005). We noted a more significant decrease in PTH levels among the cases when compared to the controls (p<0.0001). The adjusted hazard for heart failure hospitalization increased with higher PTH levels (p=0.002) and mediation analysis revealed change in PTH level as a significant mediator of heart failure hospitalization (p=0.04). Conclusion:Aldosterone antagonists may be helpful in preventing hospitalizations for heart failure exacerbation in CKD patients through a PTH-mediated effect.

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Secondary Hyperparathyroidism in Patients with Untreated and Treated Congestive Heart Failure

Cited by 49 publications

References 34 publications

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

Macro- and micronutrients in African-Americans with heart failure

Interplay of parathyroid hormone and aldosterone antagonist in prevention of heart failure hospitalizations in chronic kidney disease

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