Date of Graduation

Summer 8-8-2015

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson, PA-C

Second Advisor

Annjanette Sommers, MS, PA-C

Abstract

Background: Cardiovascular-related deaths account for nearly 30% of deaths worldwide. Age, diabetes mellitus, the male gender, and use of tobacco products have been identified as risk factors in previous studies; however, most recent research is directing attention toward other causes of cardiovascular-related mortality. Parathyroid hormone (PTH), an important component in the maintenance of mineral homeostasis, has shown to be linked to cardiovascular events when the levels are high. As a result, it becomes fundamental to seek the relationship between elevated levels of PTH in a generally healthy population aged 50 and older and cardiovascular-related mortality.

Methods: An exhaustive literature search was conducted using the following search engines: Medline-OVID, Web of Science, and CINAHL. For each literature search, the key words parathyroid hormone, cardiovascular, mortality, and adult were utilized to narrow the results. The following inclusion criteria were required in narrowing the search: studies including adults aged 50 and older, studies that measure cardiovascular-related mortality as the primary outcome, studies that investigate elevated PTH in generally healthy populations, and studies with a mean follow-up of at least seven years. Similarly, the following exclusion criteria were applied to the search: studies published before the year 2009, studies not performed on humans, and studies in a language other than English. All articles were assessed for quality using GRADE.

Results: The search resulted in 156 articles, all of which were viewed for relevancy. After the application of inclusion and exclusion criteria, two community-based cohort studies were included. Both observational studies demonstrated a position correlation between increased parathyroid hormone and cardiovascular mortality in community-dwelling adults over the age of 50. The primary outcome measured was cardiovascular mortality, and no other surrogate outcomes were used. After the GRADE assessment, both prospective cohort studies were considered to be low quality.

Conclusion: Two observational studies show a correlation between high parathyroid hormone and cardiovascular-related mortality in populations of generally healthy community-dwelling adults. At this time, the low quality evidence is not enough to support the correlation. However, due to these findings, future studies may possibly confirm use parathyroid hormone as a modifiable risk factor in the prevention of cardiovascular-related mortality.

Keywords: Parathyroid hormone, cardiovascular, mortality, and adult

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