Association between serum 25-hydroxyvitamin D level and subclinical cardiovascular disease in primary hyperparathyroidism.

Abstract

CONTEXT:

Vitamin D (25OHD) deficiency may be a modifiable cardiovascular (CV) risk factor. 25OHD insufficiency (20-29 ng/mL) and deficiency (<20 ng/mL) are common in primary hyperparathyroidism (PHPT), but their association with CV disease in PHPT has not been systematically investigated.

OBJECTIVE:

This study evaluated whether low 25OHD is associated with subclinical CV disease in PHPT.

DESIGN:

This is a cross-sectional analysis of PHPT patients with and without low 25OHD.

SETTINGS AND PARTICIPANTS:

We studied 110 PHPT patients in a university hospital setting.

OUTCOME MEASURES:

We measured carotid intima-media thickness; carotid plaque presence/thickness; carotid strain and stiffness; left ventricular mass index; cardiac systolic and diastolic function; and mitral annular calcification.

RESULTS:

Low 25OHD levels (<30 ng/mL) were observed in 28%, but only 9% had 25OHD deficiency (<20 ng/mL). In the whole group, 25OHD levels negatively correlated with body mass index (r = -0.33, P = .0005), PTH (r = -0.30, P = .001), calcium (r = -0.29, P = .002), renal function, and PHPT duration. CV indices were normal except for carotid intima-media thickness, stiffness, and plaque thickness, which were increased, regardless of 25OHD status. Isovolumic relaxation time was the only CV measure associated with 25OHD (r = -0.26, P = .01). Those with 25OHD less than 20 ng/mL had more severe PHPT and a higher rate of nephrolithiasis. Those with 25OHD less than 30 ng/mL were younger, had higher body mass index, had lower serum phosphate, and were more likely to be male, nonwhite, and Hispanic. Other than lower tissue Doppler e' and higher isovolumic relaxation time within normal range in those with 25OHD less than 30 vs greater than 30 ng/mL, there were no differences in CV indices using either 25OHD threshold.

CONCLUSIONS:

Patients with mild PHPT have subclinical carotid abnormalities, but low 25OHD is not associated with abnormal carotid or cardiac measures. To the extent that PTH levels differentiated those with 25OHD less than 20 but not 30 ng/mL, these data support a 25OHD threshold of 20 ng/mL as clinically relevant in PHPT.

• Authors: Marcella D Walker, Elaine Cong, Anna Kepley, Marco R Di Tullio, Tatjana Rundek, Shunichi Homma, James A Lee, Rui Liu, Polly Young, Chiyuan Zhang, Donald J McMahon, Shonni J Silverberg
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 99 Issue 2 Pg. 671-80 (Feb 2014) ISSN: 1945-7197 [Electronic] United States
• PMID: 24285686 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Vitamin D
• 25-hydroxyvitamin D

Topics

• Aged
• Cardiovascular Diseases (blood, diagnostic imaging, etiology)
• Carotid Intima-Media Thickness
• Cross-Sectional Studies
• Female
• Humans
• Hyperparathyroidism, Primary (blood, complications, diagnostic imaging)
• Male
• Middle Aged
• Risk Factors
• Vitamin D (analogs & derivatives, blood)
• Vitamin D Deficiency (blood, complications, diagnostic imaging)