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. 2021 Aug;8(4):2713-2722.
doi: 10.1002/ehf2.13331. Epub 2021 May 1.

Parathormone levels add prognostic ability to N-terminal pro-brain natriuretic peptide in stable coronary patients

Carlos Gutiérrez-Landaluce  1 , Álvaro Aceña  2   3 , Ana Pello  2   3 , Juan Martínez-Milla  2   3 , Óscar González-Lorenzo  2   3 , Nieves Tarín  4 , Carmen Cristóbal  1   5 , Luis M Blanco-Colio  6   7 , José Luis Martín-Ventura  3   6   7 , Ana Huelmos  8 , Marta López-Castillo  2 , Joaquín Alonso  5   9 , Lorenzo López Bescós  5 , Luis Alonso-Pulpón  3   10 , Emilio González-Parra  3   11 , Jesús Egido  3   6   11   12 , Ignacio Mahíllo-Fernández  13 , Óscar Lorenzo  3   6   12 , María Luisa González-Casaus  14 , José Tuñón  2   3   6   7
Affiliations

Parathormone levels add prognostic ability to N-terminal pro-brain natriuretic peptide in stable coronary patients

Carlos Gutiérrez-Landaluce et al. ESC Heart Fail. 2021 Aug.

Abstract

Aims: There are controversial data on the ability of the components of mineral metabolism (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor-23 [FGF23], and klotho) to predict cardiovascular events. In addition, it is unknown whether they add any prognostic value to other well-known biomarkers.

Methods and results: In 969 stable coronary patients, we determined plasma levels of all the aforementioned components of mineral metabolism with a complete set of clinical and biochemical variables, including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI), and high-sensitivity C-reactive protein. Secondary outcomes were ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and heart failure or death. The primary outcome was a composite of the secondary outcomes. Median follow-up was 5.39 years. Age was 60 (52-72) years. Median glomerular filtration rate was 80.4 (65.3-93.1) mL/min/1.73 m2 . One-hundred and eighty-five patients developed the primary outcome. FGF23, PTH, hs-TnI, and NT-proBNP were directly related with the primary outcome on univariate Cox analysis, while Klotho and calcidiol were inversely related. On multivariate analysis, only PTH (HR 1.058 [CI 1.021-1.097]; P = 0.002) and NT-proBNP (HR 1.020 [CI 1.012-1.028]; P < 0.001) were independent predictors of the primary outcome but also for the secondary outcome of heart failure or death (HR 1.066 [CI 1.016-1.119]; P = 0.009 and HR 1.024 [CI 1.014-1.034]; P < 0.001, respectively). PTH was the only biomarker that predicted ischaemic events (HR 1.052 [1.010-1.096]; P = 0.016). Patients were divided in two subgroups according to FGF23 plasma levels. PTH retained its prognostic value only in patients with FGF23 levels above the median (>85.5 RU/mL) (P < 0.001) but not in patients with low FGF23 levels (P = 0.551). There was a significant interaction between FGF23 and PTH (P = 0.002). However, there was no significant interaction between PTH and both klotho and calcidiol levels.

Conclusions: Parathormone is an independent predictor of cardiovascular events in coronary patients, adding complimentary prognostic information to NT-proBNP plasma levels. This predictive value is restricted to patients with high FGF23 plasma levels. This should be considered in the design of future studies in this field.

Keywords: Coronary artery disease; Fibroblast growth factor-23; Mineral metabolism; Parathormone.

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Conflict of interest statement

José Tuñón has given lectures for Diasorin Spain.

Figures

Figure 1
Figure 1
Primary and secondary outcomes according to PTH quartiles. FGF23, fibroblast growth factor 23; PTH, parathormone.
Figure 2
Figure 2
Predictive power of PTH for the primary outcome according to the status of FGF23, soluble klotho, and calcidiol. FGF23, fibroblast growth factor 23; PTH, parathormone.
See this image and copyright information in PMC

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