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Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis.

ABSTRACT: High circulating concentrations of parathyroid hormone (PTH) have been associated with increased risks of hypertension, left ventricular hypertrophy, congestive heart failure and cardiovascular mortality. Impaired arterial function is a potential mechanism for these associations. We tested whether serum PTH concentration is associated with measures of arterial function.Cross-sectional study.A total of 6545 persons without clinical cardiovascular disease participating in the community-based Multi-Ethnic Study of Atherosclerosis.Brachial artery flow-mediated dilation (FMD) as well as aortic pulse pressure and arterial pulse parameters derived from Windkessel modelling of the radial pressure waveform.Higher serum PTH concentration was associated with lower brachial artery FMD (mean difference -0·09% per 10 pg/ml PTH), higher aortic pulse pressure (0·53 mmHg per 10 pg/ml) and reduced Windkessel capacitive index C1 (large artery elasticity, -0·12 ml/mmHg × 10 per 10 pg/ml), adjusting for potential confounding variables (all P-values ? 0·001). These relationships were independent of serum calcium concentration, serum 25-hydroxyvitamin D concentration and estimated glomerular filtration rate and were consistent across relevant participant subgroups. Associations of PTH with aortic pulse pressure and capacitive index C1 were attenuated after adjustment for blood pressure. Serum PTH concentration was not associated with the oscillatory index C2 (small artery elasticity).Higher serum PTH concentration was associated with impaired endothelial function, increased aortic pulse pressure and decreased capacitive index C1 in a large, diverse, community-based population. These relationships may help explain previously observed associations of elevated PTH with cardiovascular disease.

SUBMITTER: Bosworth C

PROVIDER: S-EPMC3664253 | biostudies-literature | 2013 Sep

REPOSITORIES: biostudies-literature

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Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis.

Bosworth Cortney C Sachs Michael C MC Duprez Daniel D Hoofnagle Andrew N AN Ix Joachim H JH Jacobs David R DR Peralta Carmen A CA Siscovick David S DS Kestenbaum Bryan B de Boer Ian H IH

Clinical endocrinology 20130520 3

<h4>Objective</h4>High circulating concentrations of parathyroid hormone (PTH) have been associated with increased risks of hypertension, left ventricular hypertrophy, congestive heart failure and cardiovascular mortality. Impaired arterial function is a potential mechanism for these associations. We tested whether serum PTH concentration is associated with measures of arterial function.<h4>Design</h4>Cross-sectional study.<h4>Participants</h4>A total of 6545 persons without clinical cardiovascu ...[more]

PMID: 23402353

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Project description:Thiazide diuretic (TZ) use is associated with higher bone mineral density, whereas loop diuretic (LD) use is associated with lower bone density and incident fracture. Dihydropyridine-sensitive calcium channels are expressed on parathyroid cells and may play a role in parathyroid hormone (PTH) regulation. The potential for diuretics and calcium-channel blockers (CCBs) to modulate PTH and calcium homeostasis may represent a mechanism by which they influence skeletal outcomes. We hypothesized that the use of LD and dihydropyridine CCBs is associated with higher PTH, and TZ use is associated with lower PTH. We conducted cross-sectional analyses of participants treated for hypertension in the Multi-Ethnic Study of Atherosclerosis who did not have primary hyperparathyroidism or chronic kidney disease (n = 1888). We used adjusted regression models to evaluate the independent association between TZ, LD, and CCB medication classes and PTH. TZ use was associated with lower PTH when compared with non-TZ use (44.4 versus 46.9 pg/mL, p = 0.02), whereas the use of LD and CCBs was associated with higher PTH when compared with non-users of each medication class (LD: 60.7 versus 45.5 pg/mL, p < 0.0001; CCB: 49.5 versus. 44.4 pg/mL, p < 0.0001). Adjusted regression models confirmed independent associations between TZ use and lower PTH (β = -3.2 pg/mL, p = 0.0007), and LD or CCB use and higher PTH (LD: β = +12.0 pg/mL, p < 0.0001; CCB: +3.7 pg/mL, p < 0.0001). Among CCB users, the use of dihydropyridines was independently associated with higher PTH (β = +5.0 pg/mL, p < 0.0001), whereas non-dihydropyridine use was not (β = +0.58 pg/mL, p = 0.68). We conclude that in a large community-based cohort with normal kidney function, TZ use is associated with lower PTH, whereas LD and dihydropyridine CCB use is associated with higher PTH. These associations may provide a mechanistic explanation linking use of these medications to the development of skeletal outcomes. © 2016 American Society for Bone and Mineral Research.

Dataset Information

Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis.

Publications

Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis.

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