Vitamin D, parathyroid hormone and cardiovascular risk: The good, the bad and the ugly

25-Hydroxyvitamin D insufficiency and increased cardiovascular risk (CVR) association is still debated. The vitamin D (VitD)-dependent parathyroid hormone (PTH) is considered as the possible actuator of VitD effects on CVR. To investigate the association of CVR, PTH and VitD, we carried out blood pressure measurements and blood samples and collected information on dietary habits, anamnestic, clinical and metabolic data of 451 participants in the Salerno area (Southern Italy) during the World Hypertension Day (17 May). CVR was calculated according to the Framingham CVR charts. The overall population mean age was 51.6±0.7 years, and female sex was slightly prevalent (55%). VitD deficiency (<20ng/ml) was most frequent (59.7%). In this population, VitD and CVR did not correlate. VitD and PTH inversely correlated (r=-0.265, P<0.001) as expected. PTH was in direct correlation (r=0.225, P<0.001) with CVR. Elevated PTH (75 percentile; ≥49.5pg/ml) levels identify a population with higher CVR (11.8±0.5 vs. 8.5±0.3, P<0.001). In a multivariate analysis, both age and PTH correlate to CVR, but not VitD. In conclusion, VitD does not directly affect CVR in the overall population. Rather, increased PTH might be a better predictor of CVR.