Associations of parathyroid hormone and atrial fibrillation: epidemiological insights from the LURIC study.

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.