Purpose Elevated serum parathyroid hormone (PTH) was previously reported in 8 African Americans (AAs) consecutively hospitalized in February 2005 with congestive heart failure (CHF) (Am J Med Sci 2006;331:30). The contribution of hypovitaminosis D to the appearance of secondary hyperparathyroidism (SHPT) was not addressed. Melanin is a natural sunscreen.
Methods and Results Herein we report on SHPT (PTH > 65 pg/mL) and hypovitaminosis D (25(OH)D < 30 ng/mL) in a larger cohort of AAs with heart failure: 28 (18 M, 10 F; 52.8 ± 2.1 years) hospitalized with protracted (D ≥ 4 weeks) or 23 (16 M, 7 F; 49.7 ± 2.6 years) with short-term (D 1-2 weeks) decompensated failure and ejection fraction (EF < 35%), each of whom were housebound because of effort intolerance; 18 (13 M, 5 F; 51.3 ± 2.5 years) ambulatory outpatients with compensated failure (Comp) and comparable EF; and 14 outpatients without heart failure and normal EF (8 M, 6 F; 55.0 ± 3.2 years) who served as controls (Cont). An idiopathic dilated cardiomyopathy was present in 87% of those with reduced EF, who were treated with ACE inhibitor and/or loop diuretic. At the time of admission or in the outpatient clinic, we monitored serum PTH (normal 12-65 pg/mL); ionized [Ca2+]o (normal 1.10-1.30 mmol/L) and [Mg2+]o (normal 0.50-0.67 mmol/L), each determinants of PTH secretion; and 25(OH)D (normal > 30 ng/mL). We found (mean ± SEM):
Conclusions Hypovitaminosis D is prevalent among AAs, with or without heart failure, whereas SHPT was confined to those with CHF where [Ca2+]o and [Mg2+]o balance can be compromised by chronic aldosteronism and loop diuretic. The potential for macro- and micronutrient supplements in the overall management of AA with heart failure is called into question.
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