Search resultsSecondary hyperparathyroidism promotes the acute phase response - A rationale for supplemental Vitamin D in prevention of vascular events in the elderly
Title
Secondary hyperparathyroidism promotes the acute phase response - A rationale for supplemental Vitamin D in prevention of vascular events in the elderly
Publication type
Journal Article
Year of Publication
2005
Authors
Journal
Medical Hypotheses
Volume
64
Issue
5
Pagination
1022 - 1026
Date published
2005
ISBN
03069877 (ISSN)
Keywords
acute phase protein, Acute-Phase Reaction, Adipose Tissue, Aged, alcohol consumption, article, C reactive protein, cardiovascular risk, chronic patient, cytokine production, cytokine release, fibrinogen, human, Humans, Hyperparathyroidism, Secondary, interleukin 6, latitude, leisure, Liver, mortality, nutritional status, osteoblast, physical activity, primary hyperparathyroidism, priority journal, risk assessment, seasonal variation, secondary hyperparathyroidism, thromboembolism, upregulation, vascular disease, Vascular Diseases, vitamin D, vitamin supplementation, winter
Abstract
Parathyroid hormone (PTH) promotes IL-6 secretion by osteoblasts, and may also up-regulate IL-6 production in the liver and adipose tissue; this may explain why serum IL-6 is markedly elevated in primary hyperparathyroidism, and low in hypoparathyroidism. IL-6 is the chief stimulus to hepatic production of many acute phase reactants, notably fibrinogen and C-reactive protein (CRP). Mild secondary hyperparathyroidism is common in elderly people, particularly at high latitudes during the winter, owing to poor vitamin D status. This may rationalize evidence that acute phase proteins show seasonal variations and are typically elevated in the elderly, whereas leisure physical activity is associated with a reduction in these proteins. In a recent clinical trial targeting elderly chronically ill patients, administration of vitamin D reduced serum levels of both CRP and IL-6; further such studies should assess the impact of physiologically meaningful doses of vitamin D on acute phase reactants in elderly subjects likely to have poor vitamin D status. Since elevations of CRP and fibrinogen may increase risk for thromboembolic vascular events, these considerations may help to explain the excess of coronary mortality observed during winter months, and suggest a role for supplemental vitamin D in preservation of vascular health. Moderate alcohol intake is associated with reduced serum PTH as well as decreased levels of CRP and fibrinogen; conceivably, modulation of PTH mediates, at least in part, the favorable impact of moderate drinking on the acute phase reactants.