Parathormone levels add prognostic ability to N-terminal pro-brain natriuretic peptide in stable coronary patients
Author
Gutiérrez-Landaluce, Carlos; Aceña Navarro, Álvaro; Pello, Ana; Martínez-Milla, Juan; González-Lorenzo, Óscar; Tarín, Nieves; Cristóbal, Carmen; Blanco-Colio, Luis M.; Martín Ventura, José Luis; Huelmos, Ana; López-Castillo, Marta; Alonso, Joaquín; López Bescós, Lorenzo; Alonso-Pulpón, Luis; González-Parra, Emilio; Egido, Jesús; Mahíllo-Fernández, Ignacio; Lorenzo González, Óscar; González-Casaus, María Luisa; Tuñón Fernández, José LuisEntity
UAM. Departamento de MedicinaPublisher
The Heart Failure Association of the European Society of CardiologyDate
2021-05-01Citation
10.1002/ehf2.13331
ESC Heart Failure 8.4 (2021): 2713-2722
ISSN
2055-5822DOI
10.1002/ehf2.13331Funded by
This work was supported by grants from Instituto de Salud Carlos III (ISCIII) and Fondos FEDER (Fondo Europeo de Desarrollo Regional) European Union (PI05/0451, PI14/1567, PI17/01615, and PI17/01495); Spanish Society of Cardiology; Spanish Society of Arteriosclerosis; RECAVA (Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares) (RD06/0014/0035); and Instituto de Salud Carlos III FEDER (FJD biobank: RD09/0076/00101). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.Project
Gobierno de España. PI05/0451; Gobierno de España. PI14/1567; Gobierno de España. PI17/01615; Gobierno de España. PI17/01495; Gobierno de España. RD06/0014/0035; Gobierno de España. RD09/0076/00101Subjects
Coronary artery disease; Fibroblast growth factor-23; Mineral metabolism; Parathormone; MedicinaRights
© 2021 The AuthorsEsta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
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.
Files in this item
Google Scholar:Gutiérrez-Landaluce, Carlos
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Aceña Navarro, Álvaro
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Pello, Ana
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Martínez-Milla, Juan
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González-Lorenzo, Óscar
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Tarín, Nieves
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Cristóbal, Carmen
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Blanco-Colio, Luis M.
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Martín Ventura, José Luis
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Huelmos, Ana
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López-Castillo, Marta
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Alonso, Joaquín
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López Bescós, Lorenzo
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Alonso-Pulpón, Luis
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González-Parra, Emilio
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Egido, Jesús
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Mahíllo-Fernández, Ignacio
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Lorenzo González, Óscar
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González-Casaus, María Luisa
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Tuñón Fernández, José Luis
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