Article Text

  1. S. Alsafwah1,
  2. S. P. LaGuardia1,
  3. M. D. Nelson1,
  4. P. L. Johnson1,
  5. S. K. Bhattacharya1,
  6. L. D. Carbone1,
  7. K. P. Newman1,
  8. K. T. Weber1
  1. 1University of Tennessee Health Science Center and Veterans Administration Medical Center, Memphis, TN


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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