1,25-Dihydroxyvitamin D to PTH(1-84) ratios strongly predict cardiovascular death in heart failure

Damien Gruson, Benjamin Ferracin, Sylvie A. Ahn, Claudia Zierold, Frank Blocki, Douglas M. Hawkins, Fabrizio Bonelli, Michel F. Rousseau

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Abstract

Objectives Vitamin D deficiency and hyperparathyroidism are common in patients with heart failure (HF). There is a growing body of evidence supporting the role of vitamin D and parathyroid hormone (PTH) in cardiac remodeling and worsening of HF. Lack of reliable automated testing of 1,25-dihydroxyvitamin D (1,25(OH)2 D), the biologically active metabolite of vitamin D, has limited its contribution to the prognostic assessment of HF. Here, the association of 1,25(OH)2 D and PTH(1-84) levels was evaluated for prediction of cardiovascular death in chronic HF patients. Methods We conducted a single center prospective cohort including 170 chronic HF patients (females n = 36; males n = 134; NYHA II-IV; mean age: 67 years; etiology: ischemic n = 119, dilated cardiomyopathy n = 51; mean LVEF: 23%). The primary outcome was cardiovascular death. Results Serum levels of 1,25(OH)2D decreased markedly with increased HF severity. Medians were 33.3 pg/mL for NYHA-II patients, 23.4 pg/mL for NYHA-III, and 14.0 pg/mL for NYHA-IV patients (p<0.001). Most patients had levels of 25(OH)D below 30ng/mL, and stratification by NYHA functional class did not show significant differences (p = 0.249). The 1,25(OH)2D to PTH(1-84) ratio and the (1,25(OH)2 D)2 to PTH(1-84) ratio were found to be the most significantly related to HF severity. After a median follow-up of 4.1 years, 106 out of 170 patients reached the primary endpoint. Cox proportional hazard modeling revealed 1,25 (OH)2 D and the 1,25(OH)2 D to PTH(1-84) ratios to be strongly predictive of outcomes. Conclusions 1,25(OH)2 D and its ratios to PTH(1-84) strongly and independently predict cardiovascular mortality in chronic HF.

Original languageEnglish (US)
Article numbere0135427
JournalPloS one
Volume10
Issue number8
DOIs
StatePublished - Aug 26 2015

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Gruson, D., Ferracin, B., Ahn, S. A., Zierold, C., Blocki, F., Hawkins, D. M., Bonelli, F., & Rousseau, M. F. (2015). 1,25-Dihydroxyvitamin D to PTH(1-84) ratios strongly predict cardiovascular death in heart failure. PloS one, 10(8), [e0135427]. https://doi.org/10.1371/journal.pone.0135427