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Associations of parathyroid hormone and atrial fibrillation: epidemiological insights from the LURIC study
L König1, M R Grübler2,3,4, N Verheyen5
1Medical University of Vienna, Vienna, Austria.
Insights
Elevated parathyroid hormone (PTH) is independently associated with atrial fibrillation (AF) in patients undergoing coronary angiography. This finding suggests PTH may be a direct risk factor for AF, not just a marker of heart dysfunction.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Parathyroid hormone (PTH) impacts calcium regulation and cardiac signaling, with links to hypertension and cardiovascular mortality.
- Previous research suggests a connection between PTH and cardiovascular health, but its specific role in atrial fibrillation (AF) is unclear.
Purpose of the Study:
- To investigate the independent association between parathyroid hormone (PTH) levels and the prevalence of atrial fibrillation (AF).
Main Methods:
- Analysis of data from 3,201 patients in the LURIC study.
- AF diagnosis based on medical history or ECG.
- Multivariable logistic regression adjusting for confounders, including mineral metabolism and cardiac function markers.
Main Results:
- Atrial fibrillation (AF) was present in 12.2% of patients.
- Elevated PTH showed a significant association with AF (OR 3.96, p<0.001).
- This association remained significant after full adjustment for confounders (OR 2.32, p=0.009), including cardiac dysfunction markers.
Conclusions:
- Elevated PTH is independently associated with prevalent AF in patients referred for coronary angiography.
- PTH may be an independent correlate of AF, not solely a marker of cardiac dysfunction.
- Further prospective studies are required to establish causality.
Introduction:
Parathyroid hormone (PTH) influences calcium handling in cardiomyocytes and sympathetic cardiac signaling. It has been linked to arterial hypertension and cardiovascular mortality. We hypothesized that PTH is independently associated with atrial fibrillation (AF).
Methods:
We analyzed data from 3,201 patients (mean age 63 ± 13 years, 25.8% female) enrolled in the LUdwigshafen RIsk and Cardiovascular health (LURIC) study. We defined AF based on medical history or current ECG. Multivariable binary logistic regression was used to assess the association between PTH and AF, adjusting for established AF risk factors, parameters of mineral metabolism, kidney function, and concomitant medication.
Results:
AF was present in 389 patients (12.2%). PTH was significantly associated with AF in the primary multivariable model [OR 3.96 (2.32-6.76), p < 0.001]. In the fully adjusted model including mineral metabolism and medication variables, the association remained significant [OR 2.32 (1.24-4.35), p = 0.009]. The association remained significant after additional adjustment for markers of cardiac dysfunction, including invasive hemodynamic parameters.
Conclusion:
Elevated PTH was associated with prevalent AF in patients referred for coronary angiography after adjustment for common confounders. The association persisted after adjustment for structural, neurohumoral and invasive hemodynamic markers, suggesting that elevated PTH is not merely a surrogate of cardiac dysfunction but may represent an independent correlate of AF. Prospective studies are needed to clarify the temporal and causal relationship between PTH and AF.
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